骨折治疗与运动康复一体化对股骨粗隆间骨折术后疗效的影响(1)
[摘要] 目的 评价骨折治疗与运动康复一体化对股骨粗隆间骨折术后疗效的影响，分析康复治疗的必要性、有效性。方法 整群选取2013年3月—2016年3月重庆市沙坪坝区人民医院骨外科采用内固定术治疗股骨粗隆间骨折患者84例，采用随机数字表达法分组，对照组、观察组各42例；对照组采用内固定治疗+常规康复训练，观察组由骨科医师、康复医师、护士进行基于内固定与运动康复一体化的治疗；记录患者末次随访Harris评分、并发症发生率。结果 观察组末次随访Harris评分(92.5±5.6)分高于对照组(80.5±10.4)分，观察组并发症发生率38.1%低于对照组90.5%，差异有统计学意义(P<0.05)。结论 骨折治疗与运动康复一体化有助于股骨粗隆间骨折术后功能恢复，同时降低并发症发生风险。
[关键词] 股骨粗隆间骨折；运动康复功能；影响
[中图分类号] R683 [文献标识码] A [文章编号] 1674-0742(2017)02(b)-0068-03
[Abstract] Objective To evaluate the effect on integration of fracture treatment and sports restoration on the curative effect after the emoral intertrochanteric fractures operation and analyze the necessity and effectiveness of rehabilitation treatment. Methods 84 cases of patients with emoral intertrochanteric fractures adopting internal fixation in the department of bone surgery in our hospital from March 2013 to March 2016 were group selected and randomly divided into two groups with 42 cases in each， the control group adopted the internal fixation treatment and routine rehabilitation training， while the observation group adopted the integration treatment of internal fixation and sports restoration by the physicists， rehabilitation physicists and nurses， and the last follow-up Harris score and incidence rate of complications of patients were recorded. Results The last follow-up Harris score in the observation group was higher than that in the control group[(92.5±5.6)points vs (80.5±10.4)points]， and the incidence rate of complications in the observation group was lower than that in the control group， (38.1% vs 90.5%)， and the difference had statistical significance(P<0.05). Conclusion The integration of fracture treatment and sports restoration contributes to the postoperative function recovery of emoral intertrochanteric fractures operation and reduce the occurrence risks of complications.
[Key words] Emoral intertrochanteric fractures； Sports restoration function；Influence
股骨粗隆間骨折是一种常见的髋部骨折，占后者的1/2左右，占全身骨折3%～4%[1]。股骨粗隆间骨折危害极大，约1/3属于不稳定型骨折，又因多见于老年人，发病率呈快速上升，死亡率高达15%～20%，许多患者术后卧床时间长，并发症发生风险较高，术后身体机能急剧恶化[2-3]。手术是治疗股骨粗隆间骨折的首选方法，近年来内固定技术治疗有了很大的进步，手术创伤得到初步控制的。但股骨粗隆间骨折的功能恢复影响因素较多，康复训练不到位是重要原因。为进一步提高医院的股骨粗隆间骨折整体治疗效果，以2013年3月—2016年3月重庆市沙坪坝区人民医院骨外科收治的患者84例作为研究对象，采用对照研究评价治疗与运动康复一体化理念应用效果，现报道如下。
1 资料与方法
1.1 一般资料
采用对照研究，整群选取84例患者，以手术治疗的股骨粗隆间骨折患者作为研究对象。纳入标准：①明确的外伤史，采用X线检查确诊，伴髋骨疼痛等症状表现；②达到手术指标标准，Singh指数Ⅲ级以上；③认知、精神正常；④患者及其家属知情同意；⑤手术均获得成功，复位良好。排除标准：①存在手术禁忌症；②拒绝参与研究；③采用髋关节置换术；④麻醉风险等级Ⅳ级者；⑤严重的原发性运动功能障碍；⑥认知、精神障碍。其中男40例、女44例，年龄51～75岁、平均(68.1±6.2)岁。Tronzo-Evans分类标准分级：Ⅱ级14例、Ⅲ型30例、Ⅳ型35例、Ⅴ型5例。合并小粗隆骨折35例。受伤到手术时间(4.3±1.6)h。受伤原因：跌倒/摔倒53例、车祸20例、其他11例。合并其他基础性疾病56例，其中合并多种36例。ASA等级：Ⅱ级55例、Ⅲ级29例。采用锁定加压钢板(LCP)治疗50例，采用防旋型股骨近端髓内钉(PFNA)治疗34例，合并处理小粗隆骨折29例。手术时间(1.9±0.3)h。采用随机数字表达法分组，对照组、观察组各42例，两组对象年龄、性别、Tronzo-Evans分类、合并小粗隆骨折情况、受伤到手术时间、受伤原因、合并症、治疗方法、手术时间等临床资料差异无统计学意义(P>0.05)。, http://www.100md.com(陈潇)
[关键词] 股骨粗隆间骨折；运动康复功能；影响
[中图分类号] R683 [文献标识码] A [文章编号] 1674-0742(2017)02(b)-0068-03
[Abstract] Objective To evaluate the effect on integration of fracture treatment and sports restoration on the curative effect after the emoral intertrochanteric fractures operation and analyze the necessity and effectiveness of rehabilitation treatment. Methods 84 cases of patients with emoral intertrochanteric fractures adopting internal fixation in the department of bone surgery in our hospital from March 2013 to March 2016 were group selected and randomly divided into two groups with 42 cases in each， the control group adopted the internal fixation treatment and routine rehabilitation training， while the observation group adopted the integration treatment of internal fixation and sports restoration by the physicists， rehabilitation physicists and nurses， and the last follow-up Harris score and incidence rate of complications of patients were recorded. Results The last follow-up Harris score in the observation group was higher than that in the control group[(92.5±5.6)points vs (80.5±10.4)points]， and the incidence rate of complications in the observation group was lower than that in the control group， (38.1% vs 90.5%)， and the difference had statistical significance(P<0.05). Conclusion The integration of fracture treatment and sports restoration contributes to the postoperative function recovery of emoral intertrochanteric fractures operation and reduce the occurrence risks of complications.
[Key words] Emoral intertrochanteric fractures； Sports restoration function；Influence
股骨粗隆間骨折是一种常见的髋部骨折，占后者的1/2左右，占全身骨折3%～4%[1]。股骨粗隆间骨折危害极大，约1/3属于不稳定型骨折，又因多见于老年人，发病率呈快速上升，死亡率高达15%～20%，许多患者术后卧床时间长，并发症发生风险较高，术后身体机能急剧恶化[2-3]。手术是治疗股骨粗隆间骨折的首选方法，近年来内固定技术治疗有了很大的进步，手术创伤得到初步控制的。但股骨粗隆间骨折的功能恢复影响因素较多，康复训练不到位是重要原因。为进一步提高医院的股骨粗隆间骨折整体治疗效果，以2013年3月—2016年3月重庆市沙坪坝区人民医院骨外科收治的患者84例作为研究对象，采用对照研究评价治疗与运动康复一体化理念应用效果，现报道如下。
1 资料与方法
1.1 一般资料
采用对照研究，整群选取84例患者，以手术治疗的股骨粗隆间骨折患者作为研究对象。纳入标准：①明确的外伤史，采用X线检查确诊，伴髋骨疼痛等症状表现；②达到手术指标标准，Singh指数Ⅲ级以上；③认知、精神正常；④患者及其家属知情同意；⑤手术均获得成功，复位良好。排除标准：①存在手术禁忌症；②拒绝参与研究；③采用髋关节置换术；④麻醉风险等级Ⅳ级者；⑤严重的原发性运动功能障碍；⑥认知、精神障碍。其中男40例、女44例，年龄51～75岁、平均(68.1±6.2)岁。Tronzo-Evans分类标准分级：Ⅱ级14例、Ⅲ型30例、Ⅳ型35例、Ⅴ型5例。合并小粗隆骨折35例。受伤到手术时间(4.3±1.6)h。受伤原因：跌倒/摔倒53例、车祸20例、其他11例。合并其他基础性疾病56例，其中合并多种36例。ASA等级：Ⅱ级55例、Ⅲ级29例。采用锁定加压钢板(LCP)治疗50例，采用防旋型股骨近端髓内钉(PFNA)治疗34例，合并处理小粗隆骨折29例。手术时间(1.9±0.3)h。采用随机数字表达法分组，对照组、观察组各42例，两组对象年龄、性别、Tronzo-Evans分类、合并小粗隆骨折情况、受伤到手术时间、受伤原因、合并症、治疗方法、手术时间等临床资料差异无统计学意义(P>0.05)。, http://www.100md.com(陈潇)