不稳定踝关节骨折术后两种功能恢复方法的前瞻陛评价  

Evaluation of functional recovery of unstable ankle fractures after cast immobilization and early weight-bearing： a prospective trial

作　　者：周健[1] 傅一山[2] 程朝辉[1] 

机构地区：[1]浙江省台州市第一人民医院骨科,318020 [2]上海交通大学附属第六人民医院骨科

出　　处：《中华创伤骨科杂志》2009年第7期649-651,共3页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨术后早期锻炼、负重与石膏固定6周两种方法对不稳定踝关节骨折术后功能恢复是否存在差异。方法采用前瞻性研究方法，选用2003年10月至2007年10月手术治疗的踝关节骨折患者为研究对象，入院后根椐床位单双号分为两组：早期活动组和石膏固定组，按照纳入标准两组均选择50例患者。入选的所有患者均根椐AO内固定原则对踝关节骨折采用切开复位内固定。术后根椐不同的分组进行相应的功能锻炼。并对患者进行随访，包括Olerud及Tegner评分、骨折后恢复日常生活及工作时间、完全负重时间、有无关节疼痛、骨折愈合时间等。结果早期活动组46例患者获平均20．3个月（14—27个月）随访。石膏固定组45例患者获平均21．4个月（13～27个月）随访。Olerud评分均达到“好”，早期活动组评分平均为（87±21）分，略高于石膏固定组[（79±19）分]，但差异无统计学意义（P=0．25）。早期活动组和石膏固定组术后12个月Tegner评分分别为（8．4±2．3）、（8．1±2．4）分，差异无统计学意义（P=0．15）。早期活动组完全负重时问平均为（7．7±1．8）周，而石膏固定组为（11．5±3．1）周，差异有统计学意义（P=0．01）。早期活动组骨折均获得临床愈合，石膏固定组中有1例出现假关节。所有获得随访的患者均恢复日常生活及回到骨折前的工作岗位，早期活动组花费时间为（9．2±1．9）周，比石膏固定组[（10．4±1．7）周]提前约1周（P=0．47）。结论术后达到坚强内固定且有较好依从性的不稳定踝关节骨折患者，可以采用早期活动及负重等功能锻炼来促进踝关节功能的康复。Objective To evaluate the functional recovery of unstable ankle fractures prospectively after early weight-beating and cast immobilization. Methods From October 2003 to October 2007, 100 patients who had sought medical management in our department for unstable ankle fractures were enrolled in this prospective study. All patients were treated with open reduction and internal fixation （ORIF）, according to the AO/ASIF principles. They were randomized into 2 even groups, one receiving early weight-bearing and the other cast immobilization. The functional recovery was evaluated in terms of Olerud score, Tegner score, pain intensity[merical rating scale （NRS） ], full weight-bearing time, return-to-work time, and hospital stay time. Results Forty-six patients in early weight-beating group and 45 patients in immobilization group finished follow-ups. There was no difference in Olerud score, Tegner score or NRS between the 2 groups, and all patients got a good Olerud score and returned to work. Total weight-bearing time in early weight-bearing group was 4 weeks less than in immobilization group. Conclusion Early weight-bearing may be recommended for patients who have got a stable osteosynthesis of their fractured ankles as judged by their responsible surgeons, fine compliance, and a high motivation.

关 键 词：踝关节 骨折 功能恢复 康复 

分 类 号：R686[医药卫生—骨科学]