机械动力牵拉法结合递进式目标康复锻炼对旋前外旋型踝关节骨折术后功能恢复的影响  

Influence of mechanical power traction combined with progressive target rehabilitation exercise on functional recovery of pronation external rotation ankle fracture

作　　者：王士冲 赵定亮 化龙昂 黄莹[1] WANG Shichong;ZHAO Dingliang;HUA Longang;HUANG Ying(Department of Pain Treatment,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 211800,China;Department of Rehabilitation Medicine,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]南京大学医学院附属鼓楼医院疼痛科,江苏南京211800 [2]上海交通大学医学院附属瑞金医院康复医学科,上海200025

出　　处：《西部医学》2023年第8期1142-1146,1157,共6页Medical Journal of West China

基　　金：国家自然科学基金项目(81801100)。

摘　　要：目的 探讨机械动力牵拉法结合递进式目标康复锻炼对旋前外旋型(PER)踝关节骨折术后患者功能恢复效果的影响。方法 选取2017年2月—2021年2月南京大学医学院附属鼓楼医院收治的94例PERⅢ度或Ⅳ度踝关节骨折患者为观察对象,根据术后康复锻炼的方式不同分为观察组(44例)和对照组(50例)。对照组术后予以递进式目标康复锻炼,观察组在对照组基础上联合机械动力牵拉。比较两组VAS评分、踝关节背伸与跖屈角度、踝关节肿胀、AOFAS踝-后足评分、生活质量评分及并发症发生率的差异。结果 观察组患者术后3、6月VAS疼痛评分显著低于对照组(均P<0.05)。观察组患者术后2周、1月、3月、6月踝关节背伸与跖屈角度显著高于对照组(均P<0.05)。两组患者术前、术后2周、1月、3月、6月踝关节骨折患者踝关节肿胀度比较,差异均无统计学意义(均P>0.05)。观察组患者AOFAS踝-后足评分优良率高于对照组(90.9%vs 70.0%,χ^(2)=6.345,P=0.012)。观察组AOFAS踝-后足评分中异常步态、前后活动(屈/伸)评分明显高于对照组(均P<0.05)。观察组患者术后6个月的物质、心理、社会、躯体等生活质量的各维度评分明显高于对照组(均P<0.05)。两组患者并发症发生率比较差异无统计学意义(P>0.05)。结论 机械动力牵拉法结合递进式目标康复锻炼应用于PERⅢ度或Ⅳ度踝关节骨折术后患者可减轻疼痛程度,改善踝关节功能。Objective To investigate the effect of mechanical dynamic stretching combined with progressive target rehabilitation exercise on functional recovery of patients with pronation external rotation(PER)ankle fracture.Methods 94 patients with PER type III or IV ankle fractures treated in Nanjing Drum Tower Hospital from February 2017 to February 2021 were selected as the research objects.The control group was given progressive target rehabilitation exercise after operation,and the observation group was given mechanical power pulling on the basis of the treatment of control group.Statistical analysis was performed to compare the VAS scores,ankle dorsiflexion and plantar flexion angles,ankle swelling,AOFAS ankle-hindfoot score,quality of life score,and complication rate after surgery between the two groups.Results The VAS pain scores in the observation group at 3 and 6 months after operation were significantly lower than those in the control group(all P<0.05).The ankle dorsiflexion and plantar flexion angles of the observation group were significantly higher than those of the control group at 2 weeks,1 month,3 months,and 6 months after operation(all P<0.05).There was no significant difference in ankle swelling between the two groups of patients with ankle fractures before surgery at 2 weeks,1 month,3 months,and 6 months after surgery(P>0.05).The excellent and good rate of the AOFAS ankle-hindfoot score in the observation group was 90.9%(40/44),which was significantly higher than the control group by 70.0%(35/50)(χ^(2)=6.345,P=0.012).The AOFAS ankle-hindfoot scores of abnormal gait and anterior and posterior activities(flexion/extension)in the observation group were significantly higher than those in the control group(all P<0.05).The various dimensions of quality of life such as material,psychological,social,physical in the observation group 6 months after surgery were significantly higher than those in the control group(all P<0.05).There was no significant difference in the incidence of complications between the two gr

关 键 词：踝关节骨折 旋前外旋型 递进式目标康复训练 机械动力牵拉 踝关节功能 

分 类 号：R454[医药卫生—治疗学]