骨科康复一体化模式下髋臼骨折围手术期康复临床路径:一项前瞻性随机对照研究  

Perioperative rehabilitation clinical pathway of acetabular fracture in light of the integration of orthopedics and rehabilitation:a prospective randomized control trial

作　　者：王宇章 刘晓华[1] 陶莉[1] 李蔷[1] 职文倩 黄强[1] 郭险峰[1] 葛宇峰 王金辉[2] 吴新宝[2] WANG Yuzhang;LIU Xiaohua;TAO Li;LI Qiang;ZHI Wenqian;HUANG Qiang;GUO Xianfeng;GE Yufeng;WANG Jinhui;WU Xinbao(Department of Rehabilitation Medicine,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院康复医学科,北京市100035 [2]北京积水潭医院创伤骨科,北京市100035

出　　处：《中国康复理论与实践》2022年第7期745-752,共8页Chinese Journal of Rehabilitation Theory and Practice

基　　金：北京市科学技术委员会京津冀协同创新推动项目(No.Z171100004517008)。

摘　　要：目的探讨骨科康复一体化模式下髋臼骨折围手术期康复临床路径的有效性和安全性。方法2019年6月至2021年1月北京积水潭医院创伤骨科经急诊收治入院行手术治疗的髋臼骨折病例82例,按照随机数字表法分为对照组(n=41)和试验组(n=41)。对照组采用常规髋臼骨折治疗,试验组采用骨科康复一体化模式下的髋臼骨折围手术期康复临床路径进行治疗,共24周。比较两组不同治疗时期疼痛视觉模拟评分(VAS)、Barthel指数(BI)评分和Majeed骨盆功能评分。结果共获得76例病例完整随访资料。两组不同时期VAS评分均无显著性差异(|Z|<1.926,P>0.05)。试验组BI评分在出院,术后2周、6周和12周随访时均高于对照组(|Z|>2.121,P<0.05);术前和术后24周,两组BI评分均无显著性差异(|Z|<1.862,P>0.05)。试验组Majeed骨盆功能评分在术后2周、6周、12周和24周随访时均高于对照组(|Z|>2.428,P<0.05)。试验组在术后6周、12周、24周Majeed骨盆功能评分为“优”的患者数均高于对照组(χ^(2)>6.136,P<0.05)。结论与传统髋臼骨折治疗相比,基于骨科康复一体化模式下的髋臼骨折围手术期康复临床路径在改善髋臼骨折患者功能、提高日常活动能力方面安全有效。Objective To evaluate the efficacy and safety of a perioperative rehabilitation clinical pathway of acetabular fracture in light of orthopedics rehabilitation team approach.Methods A prospective randomized control trial was conducted in 82 patients with acetabular fractures who had been admitted from the Emergency Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from June,2019 to January,2021.The patients were randomly divided into control group(n=41)and intervention group(n=41).The control group was managed routinely,while the intervention group received the rehabilitation clinical pathway,for 24 weeks.The Visual Analogue Score(VAS)of pain,the Barthel Index(BI)and Majeed Pelvic Score were compared.Results Finally,76 patients completed the trial.There was no statistical difference in VAS score between two groups in all periods(|Z|<1.926,P>0.05).The BI score was higher in the intervention group than in the control group at discharge,two weeks,six weeks and twelve weeks after operation(|Z|>2.121,P<0.05);and no significant difference was found before operation and 24 weeks after operation(|Z|<1.862,P>0.05).Majeed Pelvic Score was higher in the intervention group than in the control group two weeks,six weeks,twelve weeks and 24 weeks after operation(|Z|>2.428,P<0.05).Six,twelve and 24 weeks after operation,the excellent rate of Majeed Pelvic Score was higher in the intervention group than in the control group(χ^(2)>6.136,P<0.05).Conclusion In comparison with traditional protocol in acetabular fracture,the perioperative rehabilitation clinical pathway was proved effective and of great safety in the light of the integration of orthopedics and rehabilitation mode for improving the function and activities of daily living of patients.

关 键 词：骨科康复 髋臼骨折 康复临床路径 随机对照研究 

分 类 号：R687.4[医药卫生—骨科学]