小丑照护在儿童肱骨髁上骨折术后康复中的应用  

Clown care on postoperative rehabilitation of children with supracondylar fracture of humerus

作　　者：王玲 易羽 黄玉婷 陈波 王远辉 张代英 WANG Ling;YI Yu;HUANG Yuting;CHEN Bo;WANG Yuanhui;ZHANG Daiying(Operation Room,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Department of Orthopedics,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Rehabilitation Medicine Department,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院手术室,泸州市646000 [2]西南医科大学附属医院骨科,泸州市646000 [3]西南医科大学附属医院康复医学科,泸州市646000

出　　处：《护理管理杂志》2023年第1期71-75,共5页Journal of Nursing Administration

基　　金：四川省科技厅专项资金课题(16SZ0062);四川省社科联项目(SC18EZD04);四川省保健委员会2021年保健科研课题(川干研2021-1506)。

摘　　要：目的观察小丑照护在学龄前儿童肱骨髁上骨折术后康复中的应用效果。方法选取肱骨髁上骨折GartlandⅡ型和Ⅲ型的学龄前患儿192例,随机分为观察组和对照组。对照组患儿进行常规健康教育与康复训练流程,观察组基于小丑照护的思路,采用娱乐游戏式健康教育和康复训练。观察两组术后疼痛评分、X线骨痂评分以及骨折愈合时间;并在术后3个月随访肘关节Flynn评分。结果在疼痛方面,术后1 d观察组与对照组相比,差异无统计学意义(P>0.05);术后3 d和术后5 d,观察组的疼痛评分均低于对照组,差异均有统计学意义(P<0.01)。在骨折愈合方面,观察组在术后2周、5周和8周的X线骨痂评分均高于对照组(P<0.01或P<0.05);骨折愈合时间观察组低于对照组(P<0.01)。关节功能状况,在术后3个月观察组的Flynn评分优于对照组(P<0.01)。家长满意度,观察组高于对照组(P<0.01)。结论小丑照护模式可通过“移情”有效缓解患儿术后疼痛;还可以提高健康教育的效果和依从性,加速骨折愈合和术后关节功能的恢复,提高家长满意度。Objective To observe the effect of clown care in the rehabilitation of preschool children with supracondylar fracture of humerus.Methods A total of 192 preschool children with supracondylar humeral fractures of Gartland type II and III were randomly divided into observation group and control group.The children in the control group received routine health education and rehabilitation training process,while the children in the observation group adopted entertainment and game based health education and rehabilitation training based on the idea of clown care.Postoperative pain score,X-ray callus score and fracture healing time were observed in both groups.The Flynn score of elbow joint was followed up 3 months after operation.Results In terms of pain,there was no significant difference between the observation group and the control group 1 day after operation(P>0.05).However,the pain scores in the observation group were lower than those in the control group 3 days and 5 days after operation,with significant difference(P<0.01).In terms of fracture healing,the X-ray callus scores of the observation group at 2 weeks,5 weeks and 8 weeks after operation were higher than those of the control group(P<0.01 or P<0.05).The time of fracture healing in the observation group was lower than that in the control group(P<0.01).In terms of joint function,the Flynn score of the observation group was better than that of the control group 3 months after operation(P<0.01).The satisfaction of parents in the observation group was higher than that in the control group(P<0.01).Conclusion Clown care mode can effectively relieve postoperative pain through"empathy".It can also improve the effect and compliance of health education,accelerate fracture healing and recovery of joint function after surgery,and improve parents’satisfaction.

关 键 词：小丑照护 健康教育 娱乐游戏式 儿童 肱骨髁上骨折 

分 类 号：R473.72[医药卫生—护理学]