综合康复治疗对老年股骨转子间骨折患者术后功能的影响研究  

Influence of comprehensive rehabilitation on postoperative functions in elderly patients with femoral intertrochanteric fracture

作　　者：徐小东[1] 王颜华 司徒炫明 杨雨润[1] 朱前拯[1] 杨欢[1] 陈星佐[1] 王立强[1] 陈瀛[1] 林朋[1] Xu Xiaodong;Wang Yanhua;Situ Xuanming;Yang Yurun;Zhu Qianzheng;Yang Huan;Chen Xingzuo;Wang Liqiang;Chen Ying;Lin Peng(Department of Orthopedics,China-Japan Friendship Hospital,Beijing 100029,China;Emergency Department,China-Japan Friendship Hospital,Beijing 100029,China;Department of Rehabilitation,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院骨科,北京100029 [2]中日友好医院急诊科,北京100029 [3]中日友好医院康复医学科,北京100029

出　　处：《中华创伤骨科杂志》2021年第6期543-547,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨综合康复治疗对老年股骨转子间骨折患者术后功能的影响。方法回顾性分析2015年6月至2019年6月期间中日友好医院骨科采用股骨近端防旋髓内钉固定治疗的144例老年股骨转子间骨折患者资料。根据是否采用综合康复治疗分为两组:综合康复组65例,男22例,女43例;年龄为(76.6±6.7)岁;骨折AO分型:31-A1型18例,31-A2型35例,31-A3型12例。对照组79例,男23例,女56例;年龄为(75.2±7.0)岁;骨折AO分型:31-A1型25例,31-A2型39例,31-A3型15例。综合康复组患者采用综合康复治疗,包括一般细节干预措施、多系统合并症和并发症的防治及患肢的康复功能锻炼。对照组患者行常规康复治疗。记录并比较两组患者术后6个月的疼痛视觉模拟评分(visual analog scale,VAS)、髋关节Harris评分、Barthel指数、离床时间及并发症发生率等。结果两组患者术前及术中一般资料比较差异均无统计学意义(P>0.05),具有可比性。综合康复组患者术后6个月疼痛VAS评分[(1.5±1.0)分]显著低于对照组患者[(1.9±1.2)分],髋关节Harris评分[(83.9±5.4)分]、Barthel指数(81.6±5.4)显著高于对照组患者[(80.2±7.9)分、78.2±7.9],离床时间[(2.6±1.0)d]显著短于对照组患者[(3.2±1.4)d],并发症发生率[4.6%(3/65)]显著低于对照组患者[16.5%(13/79)],差异均有统计学意义(P<0.05)。结论对于老年股骨转子间骨折患者,与常规康复治疗相比,综合康复治疗能够明显减少患者并发症的发生,促进髋关节功能康复,加快患者日常生活能力的恢复。Objective To analyze the influence of comprehensive rehabilitation on postoperative functions in the elderly patients with femoral intertrochanteric fracture.Methods From June 2015 to June 2019,144 elderly patients were treated at Department of Orthopedics,China-Japan Friendship Hospital for femoral intertrochanteric fractures by internal fixation with proximal femoral nail anti-rotation(PFNA).Of them,65 received comprehensive rehabilitation,including intervention measures for details,prevention and management of comorbidities and complications and active exercise of the injured limb,while 79 conventional rehabilitation.In the comprehensive rehabilitation group,there were 22 males and 43 females with an age of(76.6±6.7)years,and 18 cases of type 31-A1,35 cases of type 31-A2 and 12 cases of type 31-A3 by the AO type.In the control group,there were 23 males and 56 females with an age of(75.2±7.0)years,and 25 cases of type 31-A1,39 cases of type 31-A2 and 15 cases of type 31-A3 by the AO type.The 2 groups were compared in terms of visual analog scale(VAS),Harris hip score,Barthel index,postoperative ambulation time and complications at 6 months after operation.Results The 2 groups were comparable because there was no significant difference between them in the preoperative or intraoperative general data(P>0.05).The comprehensive rehabilitation group had a significantly lower VAS score(1.5±1.0),a significantly higher Harris hip score(83.9±5.4),a significantly higher Barthel index(81.6±5.4),significantly shorter postoperative ambulation time[(2.6±1.0)d],and a significantly lower incidence of complications[4.6%(3/65)]than the control group did[1.9±1.2,80.2±7.9,78.2±7.9,(3.2±1.4)d,16.5%(13/79),respectively](all P<0.05).Conclusion For elderly patients with femoral intertrochanteric fracture,comprehensive rehabilitation can significantly reduce complications,promote functional recovery of the hip,and speed up recovery of capabilities of daily living compared with conventional rehabilitation.

关 键 词：髋骨折 骨折固定术 髓内 骨钉 康复 老年人 

分 类 号：R687.3[医药卫生—骨科学]