优化康复流程对老年股骨转子间骨折EvansⅢ、Ⅳ型患者预后的影响  

Impact of optimized rehabilitation process on prognosis of old patients with Evans type Ⅲ and Ⅳ femoral intertrochanteric fractures

作　　者：李正云[1] 范远俊 陈增刚[1] Li Zhengyun;Fan Yuanjun;Chen Zenggang(Department of Orthopedics,People’s Hospital Banan District,Chongqing 401320,China)

机构地区：[1]重庆市巴南区人民医院骨科,401320

出　　处：《中华创伤杂志》2020年第3期233-239,共7页Chinese Journal of Trauma

摘　　要：目的探讨优化康复流程对老年股骨转子间骨折EvansⅢ、Ⅳ型患者预后的影响。方法采用回顾性病例对照研究分析2012年3月—2017年1月重庆市巴南区人民医院收治的股骨近端防旋髓内钉(PFNAⅡ)固定的207例股骨转子间骨折老年EvansⅢ、Ⅳ型老年患者临床资料。100例术后开始康复教育训练,术后下床时间>48 h(普通康复组),其中男38例,女62例;年龄65~75岁69例,≥75岁31例。EvansⅢ型49例,EvansⅣ型51例。107例入院即开始康复教育训练,术后下床时间<48 h(优化康复组),其中男43例,女64例,年龄65~75岁79例,≥75岁28例。EvansⅢ型63例,EvansⅣ型44例。记录并比较两组手术时间、术中出血量、术后住院期间并发症、骨折愈合时间、术后12个月内固定断裂、股骨头切割、再次骨折及病死率、术后3,6及12个月髋关节功能Harris评分。结果患者均获随访3~12个月,平均11.6个月。普通康复组手术时间为(1.13±0.22)ml,术中出血量为(119.3±1.9)ml;优化康复组手术时间为(1.07±0.25)h,术中出血量为(121.6±1.2)ml(P>0.05)。优化康复组术后住院期间并发症(坠积性肺炎6例,心力衰竭和急性心肌梗死1例,泌尿系感染6例,下肢深静脉血栓1例,压疮0例)、术后3个月病死率(0)低于普通康复组并发症(坠积性肺炎19例,心力衰竭和急性心肌梗死8例,泌尿系感染18例,下肢深静脉血栓5例,压疮4例)和病死率(5%)(P<0.05)。骨折愈合时间、术后 12个月内固定断裂、股骨头切割、再次骨折、病死率两组比较差异均无统计学意义(P>0.05)。优化康复组术后3,6及12个月的髋关节功能Harris评分[(69.7±6.3)分、(80.2±4.6)分、(89.3±10.2)分]高于普通康复组[(53.6±5.4)分、(75.1±9.2)分、(77.5±7.5)分](P<0.05)。结论对老年股骨转子间骨折EvansⅢ、Ⅳ型患者优化康复流程,入院即开始教育康复、术后下床时间<48 h早期康复,可以促进髋关节功能恢复、减少术后内科并发症�Objective To evaluate the influence of optimized rehabilitation process on prognosis of old patients with Evans type Ⅲ and Ⅳ femoral intertrochanteric fractures and investigate the related efficacy.Methods A retrospective case-control study was performed on 207 old patients with Evans type Ⅲ and Ⅳ femoral intertrochanteric fractures fixed by proximal femoral nail anti-rotation(PFNAⅡ)in People's Hospital of Chongqing Banan District from March 2012 to January 2017.Normal rehabilitation group(n=100)had rehabilitation education and training after operation and started off bed exercise at postoperative 48 hours,including 38 males and 62 females,with age from 65 to 75 years in 69 patients and 75 years and over in 31 patients.There were 49 patients with Evans type Ⅲ fractures and 51 with Evans Ⅳ fractures.Optimized rehabilitation group(n=107)had rehabilitation education and training at admission and started off bed exercise within 48 hours after operation,including 43 males and 64 females,with age from 65 to 75 years in 79 patients and 75 years and over in 28 patients.There were 63 patients with Evans Ⅲ fractures and 44 with Evans Ⅳ fractures.Operation time,intraoperative bleeding,complications during hospital stay,fracture healing time,internal fixation rupture,femoral head cut,second fracture and mortality rate were recorded and compared between the two groups.Harris hip score was evaluated at postoperative 3,6 and 12 months.Results All patients were followed up for 3-12 months,with the average of 11.6 months.Normal rehabilitation group showed introperative bleeding of(119.3±1.9)ml and operation time of(1.13±0.22)hours,which were not significantly differed from that in optimized rehabilitation group[(121.6±1.2)ml,(1.07±0.25)h](P>0.05).In normal rehabilitation group,the complications were hypostatic pneumonia in 19 patients,heart failure or acute myocardial infarction in 8,urinary infection in 18,lower extremity deep vein thrombosis in 5,pressure ulcer in 4,with 5 deaths within 3 months after surg

关 键 词：髋骨折 老年人 康复 

分 类 号：R687.3[医药卫生—骨科学]