直接前方入路全髋关节置换术患者运动干预的最佳证据总结

Summary of Best Evidence for Exercise Interventions in Patients Undergoing Direct Anterior Approach Total Hip Arthroplasty

摘要: 直接前方入路全髋关节置换术因其微创优势在临床中应用日益广泛，但针对该入路患者的术后运动康复方案尚缺乏统一共识。本研究系统检索中国知网、万方、PubMed等中英文数据库，共纳入7篇高质量文献，并基于JBI证据预分级系统提炼出23条相关证据。结果显示，直接前入路全髋关节置换患者建议在医学条件允许情况下尽早启动康复训练。个体康复进程应体现递进性与阶段性：早期以低强度功能性活动为主，随恢复进程逐步引入抗阻训练，后期则侧重于全面提升关节功能与运动耐力。值得注意的是，有证据表明在术后一周内、在专业监督下开展特定高强度抗阻训练(如腿举及髋外展)具备可行性。为降低术后脱位风险，应重视术后6周内避免髋关节的强制伸展与外旋，并需持续关注股外侧皮神经可能出现的感觉障碍。本研究基于当前可得证据，提出适用于直接前入路全髋关节置换术患者的运动康复建议，为临床实践提供参考。然而，部分推荐意见所依据的研究仍有限，在不同临床场景中的适用性尚需通过更多高质量的专项研究加以验证。建议医护人员在实践应用中，应充分评估患者个体情况与医疗资源，审慎、灵活地参考本研究结论，以制定真正符合患者需求的个性化康复计划。

Abstract: The direct anterior approach (DAA) in total hip arthroplasty (THA) has gained increasing clinical popularity due to its minimally invasive advantages. However, a unified consensus on postoperative exercise rehabilitation protocols for patients undergoing DAA-THA remains lacking. This study systematically searched both Chinese and English databases, including CNKI, Wanfang, and PubMed, and included seven high-quality studies. Based on the JBI evidence pre-grading system, 23 pieces of relevant evidence were extracted. The results suggest that, when medically permissible, early initiation of rehabilitation training is recommended for DAA-THA patients. The individual rehabilitation process should be progressive and staged: early rehabilitation should focus on low-intensity functional activities, gradually introducing resistance training as recovery progresses, and later emphasizing comprehensive improvement of joint function and exercise endurance. Notably, evidence indicates that specific high-intensity resistance exercises (such as leg press and hip abduction) conducted under professional supervision within the first postoperative week are feasible. To minimize the risk of postoperative dislocation, excessive hip extension and external rotation should be avoided within six weeks after surgery, and attention should be paid to potential sensory disturbances of the lateral femoral cutaneous nerve. Based on the currently available evidence, this study provides exercise rehabilitation recommendations for patients undergoing DAA-THA, offering a reference for clinical practice. However, as some recommendations are derived from limited studies, their applicability in diverse clinical settings requires further validation through high-quality specialized research. Clinicians are advised to comprehensively evaluate individual patient conditions and available medical resources, and to apply these recommendations prudently and flexibly to develop truly personalized rehabilitation programs.