跟骨骨折术后开始锻炼时间对足功能恢复的影响:6个月随访盲法评估(英文)  

Effect of early dirigation on the recovery of foot function after the operation of the fracture of calcaneus: the blind evaluation based on 6-month follow-up

作　　者：沈奕[1] 王伟力[1] 韩晓峰[1] 

机构地区：[1]上海第二医科大学附属仁济医院骨科,上海市200127

出　　处：《中国临床康复》2005年第18期220-221,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：背景:移位的跟骨骨折多需手术治疗。由于术后缺少早期的康复锻炼,许多患者虽然得到了良好的手术复位,却未获得相应的良好功能。目的:比较累及关节面的移位跟骨骨折术后不同时间开始功能锻炼对足部关节功能的影响。设计:非随机化同期对照的回顾性分析,盲法评估。单位:上海第二医科大学附属仁济医院骨科。对象:2000-10/2003-06上海第二医科大学附属仁济医院骨科收治的累及关节面的移位跟骨骨折患者64例(72侧)男40侧,女32侧;年龄22～68岁。根据术后功能锻炼情况分为两组,1周锻炼组34例患者38侧,男20侧,女18侧。6周锻炼组30例患者34侧,男20侧,女14侧。方法:64例患者均进入结果分析。两组患者采用相同的手术治疗方法和术后功能锻炼方法,而开始功能锻炼的时间不同,分别于术后1,6周开始功能锻炼,锻炼6周。6个月后随访时按照Maryland足部评分标准(优90～100分,良75～89分,中50～74分,差<50分)评价患者术后6个月时距小腿关节的活动度和前半足的稳定性及步态。主要观察指标:主要结局:两组患者术后患足功能。次要结局:不良事件和副反应。结果:按意向处理分析,6个月随访率100%。①Maryland足部评分:1周锻炼组34例(38侧)平均为87.8分,6周锻炼组30例(34侧)平均为73.2分,两组比较差异意义显著(P<0.01)。②并发症:1周锻炼组切口愈合不良3例,经换药2周愈合,足背外侧皮神经损伤2例;6周锻炼组中切口愈合不良2例,经换药2周愈合,足背外侧皮神经损伤1例。两组无明显差别。结论:跟骨骨折术后实施早期功能锻炼对患者获得良好的足及距小腿关节功能是有益的,且不存在非安全性问题。BACKGROUND:Most of the displaced fractures of calcaneus need operation treatm ent.Because early postoperative dirigation is sometimes ignored,most patients re ceive only good anatomic reduction but less pleased functional reduction. OBJECTIVE:To compare the effect of different starting time of the postoperati ve dirigation on the functional recovery of the joint of the foot after the oper ation of the fracture of calcaneus with joint surface displacement. DESIGN:Non- randomized and concurrently controlled retrospective analysis wi th blind evaluation. SETTING:Orthopedic Department of Renji Hospital of Shanghai Second Medical Un iversity. PARTICIPANTS:Cases with the fracture of the calcaneus with joint surface disp lacement,in the Orthopedic Department of Renji Hospital of Shanghai Second Medic al University were chosen from October 2000 to June 2003.There were totally 64 c ases(72 sides),male 40 sides and female 32 sides,whose ages varied from 22 to 68 years old.According to the starting time of the postoperative dirigation,the ca ses were divided into two groups,the 1- week dirigation group with 34 cases(38 sides),male 20 sides and female 18 sides,and the 6- week dirigation group with 30 cases(34 sides),male 20 sides and female 14 sides. METHODS: Totally 64 cases were involved in the result analysis.In the two gro ups,the same operative therapeutic methods and postoperative dirigation were tak en except the starting time of the dirigation.The dirigation was started respect ively 1 or 6 weeks after the operation and lasted for 6 weeks.Six months later,f ollow- ups were done according to the Maryland Grade(excellent 90- 100,good 75 - 89,moderate 50- 74,poor < 50) to evaluate the activity of the talocrural joi nt and the stability of the anterior half of the foot and the gait as well. MAIN OUTCOME MEASURES: Primary results: the postoperative function of the in jured foot of the two groups.Secondary results:the adverse events and side effec t. RESULTS: The intent analysis was done and the follow- up ratio was 100% .

关 键 词：跟骨 骨折 功能恢复 

分 类 号：R683[医药卫生—骨科学]