应用主观活动功能评估预测老年患者髋关节置换后的活动功能

背景：置换前步行能力和活动功能能够很好的预测患者髋关节置换后的康复和功能状态，但对于置换前没有任何行走能力的股骨颈骨折患者来说，无法使用这些客观评估手段来预测置换后功能效果。目的：探讨置换前主观活动功能评估对老年髋关节置换患者置换后6个月活动功能预测的效果，并分析影响置换后6个月活动功能的患者特征资料。方法：前瞻性研究了两个中心在2010年11月和2013年2月期间收治的髋关节置换病例，分为股骨颈骨折行全髋关节置换组、髋关节骨性关节炎行全髋关节置换组和股骨颈骨折行人工股骨头置换组。评估各组患者的特征资料、伤前（骨折患者）或置换前（骨性关节炎患者）2周SF-36评分和LAPAQ评分与置换后6个月患者主观和客观活动功能评价的相关性。置换后6个月主观功能评价包括LAPAQ问卷调查表、SF-36评分量表，客观功能评价包括起立-行走测定和六分钟步行测试。结果与结论：115例患者完成研究。①置换前LAPAQ评分和SF-36评分均能预测股骨颈骨折和骨性关节炎患者在髋关节置换后6个月的主观和客观活动功能状态。置换前LAPAQ评分对置换后活动功能的预测似乎优于置换前SF-36评分。对于置换前无法用客观活动功能评价的髋部骨折患者来说，置换前LAPAQ评分是一种预测置换后6个月活动功能的方法。②与置换前相比，股骨颈骨折患者在术后6个月能够恢复到伤前的70%-80%活动功能，骨性关节炎患者在置换后活动功能明显优于置换前，在置换后6个月，能够增加约27%活动功能。③患者的基本特征也影响置换后的活动功能，其中并发症数是影响置换后6个月功能最主要的因素。

Preoperative prediction of early physical function in elder patients undergoing hip arthroplasty using a subjective physical activity questionnaire

BACKGROUND： Preoperative walking ability and activities are good predictors of functional recovery of patients after hip replacement. But these objective assessment tools are invalid to predict postoperative function of patients with no preoperative walking ability.
OBJECTIVE： To assess the effect of preoperative subjective physical activity questionnaire to predict the 6-month postoperative physical functioning outcomes in elder patients receiving hip arthroplasty, and to determine which aspects of patient＇s characteristics influence 6-month postoperative physical activity.
METHODS： A two-center prospective audit was carried out in elder patients who underwent hip arthroplasty between November 2010 and February 2013. These patients were divided into three groups, including the group of total hip arthroplasty for fractures of the femoral neck, the group of total hip arthroplasty for osteoarthritis and the group of hemiarthroplasty for fractures of the femoral neck. All patients had fulfilled Longitudinal Aging Study Amsterdam-Physical Activity Questionnaire （LAPAQ） and Short Form 36 （SF-36） recalling their physical activity at 2 weeks before the fall accident （for fractures of the femoral neck） or admission （for hip osteoarthritis）. Preoperative demographic data were also collected. Postoperative assessment regarding subjective physical activity assessment including LAPAQ and SF-36, and objective physical activity assessment including timed up and go test and six-minute walk test were evaluated at the time of 6-month postoperation.
RESULTS AND CONCLUSION： Totally 115 patients finished the study. Both preoperative LAPAQ and SF-36 can play a predictor to probe 6-month postoperative function of objective and subjective activity in patients with femoral neck fractures or hip osteoarthritis undergoing hip arthroplasty. Preoperative LAPAQ seems better than preoperative SF-36 to predict postoperative physical activity. For hip fracture patients, because preoperative objective function cannot be assessed, preoperative LAPAQ can play an effective and subjective index to predict postoperative function of objective activity, and physical functions can recover 70%-80% at 6 months postoperatively. For hip osteoarthritis patients, postoperative physical function can be increased by approximately 27% compared with before hip arthroplasty. Patient＇s characteristics also affect the postoperative physical activity, and the occurrence of preoperative complications is a most important factor.