加速康复外科中围手术期运动疗法联合营养补充对全髋关节置换术后功能恢复的影响。

Effects of perioperative exercise therapy combined with nutritional supplementation on functional recovery after fast-track total hip arthroplasty.

机构信息

Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan; Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.

Department of Orthopaedic Surgery of Clinical Medicine, Rehabilitation Sciences and Functional Restoration, Science of Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.

出版信息

J Orthop Sci. 2023 Nov;28(6):1291-1297. doi: 10.1016/j.jos.2022.09.012. Epub 2022 Oct 19.

DOI:10.1016/j.jos.2022.09.012

PMID:36272926

Abstract

BACKGROUND

The combination of exercise therapy combined with nutritional supplementation (Nutr) is widely used for frail or sarcopenic older persons. However, the effects of Nutr in elderly patients after fast-track total hip arthroplasty (THA) are unknown. This study examined the effects of perioperative Nutr on muscle strength, functional performance, and quality of life (QOL) in frail elderly women after fast-track THA.

METHODS

A total of 58 frail elderly women aged 65-80 years scheduled for unilateral primary THA were randomly allocated to two groups: the physical exercise (Ex) combined with Nutr (Ex + Nutr; n = 29) group, and the Ex alone (Ex; n = 29) group. Protein and vitamin D supplements were provided daily from 4 weeks preoperatively to 8 weeks postoperatively (12 weeks) to the patients in the Ex + Nutr group, whereas the Ex group did not receive any supplements. Surgery and postoperative rehabilitation programmes during intervention were identical in both groups. Hip abductor and knee extensor muscle strength, functional performance (Timed Up & Go test, Harris Hip Score), and QOL (Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire) were assessed at baseline and at 12 weeks (8 weeks postoperatively).

RESULTS

After the intervention, hip abductor muscle strength on the contralateral leg and knee extensor muscle strength on both sides significantly improved in the Ex + Nutr group compared to the Ex group (p = 0.03, 0.01, and 0.01, respectively). However, hip abductor muscle strength on the operated side did not differ significantly between the groups (p = 0.23). There were no significant differences in functional performance and QOL.

CONCLUSION

Ex + Nutr does not have an additional effect on the improvement of hip abductor strength, functional performance, and QOL compared to Ex alone after fast-track THA. However, significant improvements were observed in the strength of some muscles after fast-track THA.

TRIAL REGISTRATION

UMIN 000042964.

THE IRB APPROVAL

This study was approved by the Mirai Iryo Reesearch Center (approval number TGE1602-115).

摘要

背景

运动疗法结合营养补充（Nutr）广泛用于虚弱或肌少症老年人。然而，围手术期 Nutr 对快速通道全髋关节置换术（THA）后老年患者的影响尚不清楚。本研究旨在探讨围手术期 Nutr 对快速通道 THA 后虚弱老年女性肌肉力量、功能表现和生活质量（QOL）的影响。

方法

共纳入 58 名年龄在 65-80 岁之间拟行单侧初次 THA 的虚弱老年女性，随机分为两组：运动（Ex）联合营养（Ex+Nutr；n=29）组和单独运动（Ex；n=29）组。从术前 4 周至术后 8 周（12 周），Ex+Nutr 组患者每天接受蛋白质和维生素 D 补充，而 Ex 组患者不接受任何补充。两组患者的手术和术后康复方案相同。在基线和 12 周（术后 8 周）时评估髋外展肌和膝关节伸肌力量、功能表现（计时起立行走测试、Harris 髋关节评分）和 QOL（日本矫形协会髋关节疾病评估问卷）。