老年人工髋关节置换术后假体脱位恐惧与恐动症的评估及阶梯式干预进展

Advances in the Assessment and Stepwise Interventions for Fear of Prosthesis Dislocation and Kinesiophobia after Total Hip Arthroplasty in Elderly Patients

摘要: 老年全髋关节置换术(THA)术后早期活动是加速康复外科核心，但恐动症与假体脱位恐惧(FoD)阻碍康复。THA术后恐动症发生率高，假体脱位约占并发症17%且多见于早期，患者易陷入“恐惧–回避”循环，导致步态异常、血栓及失能。本文综述二者交互机制：FoD为恐动症提供具体威胁锚点，扩展恐惧–回避模型引入“假体威胁评估”，解释“越怕脱位越易脱位”悖论；肌少症、本体感觉退化、跌倒史及照护者过度保护可放大风险。评估以TSK-11为主，但THA特异性FoD量表缺失，可穿戴传感器、AI角度仪可作客观补充，并按TSK-11分轻、中、重三级。干预构建“分层、分期、循序渐进”阶梯方案：一级安全边界教育与环境改造；二级分级暴露、动作观察及照护者赋能；三级VR脱敏、智能反馈鞋垫及闭环随访。未来需开发特异性量表，推进客观监测标准化，开展多中心随机对照试验验证阶梯干预，优化闭环管理，促进心理–功能协同康复。

Abstract: Early mobilization after total hip arthroplasty (THA) in elderly patients is a core component of enhanced recovery after surgery (ERAS), but kinesiophobia and fear of dislocation (FoD) hinder rehabilitation. The incidence of kinesiophobia after THA is high, and prosthesis dislocation accounts for approximately 17% of complications and mostly occurs early postoperatively. Patients easily fall into a “fear-avoidance” cycle, leading to gait abnormalities, thrombosis, and disability. This review summarizes the interaction mechanisms between the two: FoD provides a specific threat anchor for kinesiophobia; an extended fear-avoidance model introduces “prosthesis threat appraisal,” explaining the paradox that “the more afraid of dislocation, the more likely dislocation occurs.” Sarcopenia, proprioceptive degeneration, fall history, and caregiver overprotection can amplify the risk. Assessment mainly relies on TSK-11, but a THA-specific FoD scale is lacking; wearable sensors and AI angle measurement devices can serve as objective supplements, and patients can be classified into mild, moderate, and severe grades based on TSK-11. Interventions construct a “stratified, staged, stepwise” ladder program: level 1 includes safety boundary education and environmental modification; level 2 includes graded exposure, action observation, and caregiver empowerment; level 3 includes VR desensitization, smart feedback insoles, and closed-loop follow-up. Future efforts should develop specific scales, promote standardization of objective monitoring, conduct multicenter randomized controlled trials to verify ladder interventions, optimize closed-loop management, and promote psychological-functional collaborative rehabilitation.