术前心肺适能对全髋关节和膝关节置换术后功能及主观结果的影响：一项单中心观察性研究。
The effect of pre-operative cardiorespiratory fitness on functional and subjective outcomes following total hip and knee arthroplasty: a single centre, observational study.
作者信息
Roxburgh Brendon H, Campbell Holly A, Cotter James D, Reymann Ulla, Williams Michael Ja, Gwynne-Jones David P, Thomas Kate N
机构信息
Lecturer, School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand; Department of Surgical Sciences, University of Otago, Dunedin, New Zealand; HeartOtago, University of Otago, Dunedin, New Zealand.
Assistant Research Fellow, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand; HeartOtago, University of Otago, Dunedin, New Zealand.
出版信息
N Z Med J. 2025 May 2;138(1614):19-41. doi: 10.26635/6965.6855.
AIM
The aim of this study was to assess the effect of pre-operative cardiorespiratory fitness (peak VO2) on physical and subjective recovery from total hip or knee arthroplasty. A secondary aim was to assess the relationship between daily step count or estimated peak VO2 via the Duke Activity Status Index (DASI) questionnaire, on post-operative recovery.
METHODS
In this secondary analysis of a prior randomised controlled trial, 51 patients (69 [8] y; 25 female; peak VO2: 20.1 [7.8] mL/min/kg) scheduled for total hip (n=23) or knee (n=28) arthroplasty underwent pre-operative assessment (cardiopulmonary exercise testing, physical function tests [30-second sit to stand, timed up and go, knee range of motion]), accelerometry and subjective questionnaire (DASI). Post-operative assessments included length of hospital stay, the Surgical Recovery Scale (SRS) and repeated functional assessments.
RESULTS
A low pre-operative peak VO2 (i.e., <15mL/min/kg) was associated with five fewer sit-to-stand reps (95% CI [confidence interval]: 3 to 7; p=0.002), 3,500 fewer daily steps (95% CI: 1,053 to 5,867; p=0.006) and poorer subjective surgical recovery at 7-days (-12 arbitrary units [AU], 95% CI: -3 to -22, p=0.014) and 6-weeks post-operative (-13 AU, 95% CI: -5 to -21; p=0.003). Estimated pre-operative peak VO2 using the DASI questionnaire was moderately correlated with post-operative daily step count (r=0.51, p <0.001); post-operative daily step count increased by 500 steps for every 1mL/min/kg increase in estimated peak VO2.
CONCLUSION
Pre-operative peak VO2 was associated with physical and subjective recovery following total hip or knee arthroplasty. Daily step count and estimated peak VO2 via the DASI questionnaire had similar moderate associations with post-operative functional outcomes as directly measured pre-operative peak VO2 and may be acceptable alternatives to predict recovery following hip or knee arthroplasty.
目的
本研究旨在评估术前心肺适能（峰值摄氧量）对全髋关节或膝关节置换术后身体恢复及主观感受恢复的影响。次要目的是评估每日步数或通过杜克活动状态指数（DASI）问卷估算的峰值摄氧量与术后恢复之间的关系。
方法
在对一项既往随机对照试验的二次分析中，51例计划接受全髋关节置换术（n = 23）或膝关节置换术（n = 28）的患者（年龄69 [8]岁；女性25例；峰值摄氧量：20.1 [7.8] mL/（min·kg））接受了术前评估（心肺运动试验、身体功能测试[30秒坐立试验、计时起立行走试验、膝关节活动范围]）、加速度计测量以及主观问卷调查（DASI）。术后评估包括住院时间、手术恢复量表（SRS）以及重复的功能评估。
结果
术前峰值摄氧量较低（即<15 mL/（min·kg））与坐立重复次数少5次相关（95%置信区间[CI]：3至7；p = 0.002），每日步数少3500步（95% CI：1053至5867；p = 0.006），且术后7天（-12任意单位[AU]，95% CI：-3至-22，p = 0.014）和术后6周（-13 AU，95% CI：-5至-21；p = 0.003）主观手术恢复较差。使用DASI问卷估算的术前峰值摄氧量与术后每日步数中度相关（r = 0.51，p <0.001）；估算的峰值摄氧量每增加1 mL/（min·kg），术后每日步数增加500步。
结论
术前峰值摄氧量与全髋关节或膝关节置换术后的身体恢复及主观感受恢复相关。每日步数以及通过DASI问卷估算的峰值摄氧量与术后功能结局的关联程度与术前直接测量的峰值摄氧量相似，且为中度相关，可能是预测髋关节或膝关节置换术后恢复情况的可接受替代指标。
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