股骨粗隆间骨折术后早期负重在适宜人群中的效果

doi:10.3969/j.issn.1006-9771.2020.08.015

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (8): 955-959.doi: 10.3969/j.issn.1006-9771.2020.08.015

股骨粗隆间骨折术后早期负重在适宜人群中的效果

何燕倩^1a,阮兢^1a(),冯国栋^1a,林小英^1a,吴杨鹏^1a,万伟霞^1a,蔡弢艺^1b,黄国峰^1b,陈志达^1b,欧建林²

1.厦门大学附属东南医院,a.康复医学科;b.骨科,福建漳州市 363000
2.暨南大学附属第一医院,广东广州市 510630

收稿日期:2019-12-16 修回日期:2020-03-28 出版日期:2020-08-25 发布日期:2020-08-31
通讯作者: 阮兢 E-mail:ke2002217@163.com
作者简介:何燕倩(1991-),女,汉族,福建漳州市人,康复治疗师,主要研究方向：骨科康复。
基金资助:
第一七五医院青年苗圃基金项目(17Y017)

Effect of Early Weight-bearing on Appropriate Population with Intertrochanteric Fracture after Surgery

HE Yan-qian^1a,RUAN Jing^1a(),FENG Guo-dong^1a,LIN Xiao-ying^1a,WU Yang-peng^1a,WAN Wei-xia^1a,CAI Tao-yi^1b,HUANG Guo-feng^1b,CHEN Zhi-da^1b,OU Jian-lin²

1. a. Department of Physical Medicine and Rehabilitation;b. Department of Orthopaedics, Affiliated Dongnan Hospital of Xiamen University, Zhangzhou, Fujian 363000, China
2. the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, China

Received:2019-12-16 Revised:2020-03-28 Published:2020-08-25 Online:2020-08-31
Contact: RUAN Jing E-mail:ke2002217@163.com
Supported by:
Youth Miaopu Fund of the 175th Hospital(17Y017)

摘要/Abstract

摘要：

目的观察股骨粗隆间骨折术后早期负重在适宜人群中的康复疗效。方法 2017年4月至2018年12月,本院骨科Evans-Jensen Ⅱ型股骨粗隆间骨折行股骨近端防旋髓内钉(PFNA)内固定术后,且骨折复位符合股内侧皮质阳性支撑(PMCS)的患者45例随机分成对照组( n= 22)和试验组(n = 23)。对照组于术后6周行耐受性负重,试验组于术后48 h内行耐受性负重,均由每次10 min、每天3次逐渐递增至每次20 min、每天5次,直到骨折临床愈合。比较两组的住院时间、住院费用、骨折临床愈合时间和并发症,术后6周、3个月、6个月比较疼痛视觉模拟评分(VAS)和Harris髋关节评分。结果试验组住院时间明显短于对照组(t =3.716, P < 0.01);住院费用低于对照组,但无显著性差异( t = 1.540,P > 0.05);骨折临床愈合时间显著短于对照组( t =6.248, P < 0.001)。试验组并发症发生率低于对照组,但无显著性差异( χ² = 2.198, P > 0.05)。术后6周、3个月和6个月,两组VAS均无显著性差异( t < 1.330, P > 0.05)。试验组术后6周Harris髋关节评分显著高于对照组( t = -5.115, P < 0.001),两组术后3个月和6个月无显著性差异(| t| < 1.799, P > 0.05)。结论 Ⅱ型股骨粗隆间骨折PFNA内固定术后,且骨折复位符合PMCS的患者于术后48 h内行耐受性负重可减少住院时间,促进骨折愈合和早期髋关节功能的康复。

关键词: 股骨粗隆间骨折, 负重, 康复

Abstract:

Objective To observe the effect of early weight-bearing on the appropriate population with intertrochanteric fracture after surgery. Methods From April, 2017 to December, 2018, a total of 45 patients with Evans-Jensen type II intertrochanteric fracture and fracture reduction as positive medial cortex support (PMCS) after proximal femoral nail anti-rotation (PFNA) fixation were randomly divided into control group (n= 22) and experimental group (n = 23). Weight-bearing as tolerated (WBAT) was initiated from six weeks after surgery in the control group, and within 48 h after surgery in the experimental group. The frequency of WBAT in two groups increased gradually from three times a day for ten minutes a time to five times a day for 20 minutes a time until clinical healing of fracture. The length of stay, hospital cost, the fracture healing time and the complication incidence were compared between two groups, as well as the scores of Visual Analogue Scale (VAS) and Harris Hip Score at six weeks, three months and six months after surgery.Results Compared with the control group, the length of stay was shorter (t =3.716, P < 0.01), the hospital cost was lower, but no significant difference was found ( t = 1.540,P > 0.05), and the fracture healing time was shorter ( t =6.248, P < 0.001) in the experimental group. The complication incidence was lower in the experimental group, but there was no significant difference ( χ²= 2.198, P > 0.05). Six weeks, three months and six months after surgery, there was no significant difference in the score of VAS between two groups ( t < 1.330, P > 0.05). The score of Harris Hip Score was significantly higher in the experimental group than in the control group six weeks after surgery ( t = -5.115, P < 0.001), however, no significant difference was found in other time points (| t| < 1.799, P > 0.05). Conclusion Early weight-bearing within 48 h after PFNA fixation for Evans-Jensen type II intertrochanteric fractures and reduction with PMCS could shorten the length of stay, shorten the bony healing time and promote early recovery of hip function.

Key words: intertrochanteric fracture, weight-bearing, rehabilitation

中图分类号:

R681.8

何燕倩,阮兢,冯国栋,林小英,吴杨鹏,万伟霞,蔡弢艺,黄国峰,陈志达,欧建林. 股骨粗隆间骨折术后早期负重在适宜人群中的效果[J]. 《中国康复理论与实践》, 2020, 26(8): 955-959.

HE Yan-qian,RUAN Jing,FENG Guo-dong,LIN Xiao-ying,WU Yang-peng,WAN Wei-xia,CAI Tao-yi,HUANG Guo-feng,CHEN Zhi-da,OU Jian-lin. Effect of Early Weight-bearing on Appropriate Population with Intertrochanteric Fracture after Surgery[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(8): 955-959.

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参考文献 26

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组别	n	性别 (男/女,n)	年龄(岁)	身高(m)	体质量(kg)	体质量指数 (kg/m²)	致伤原因(n)
组别	n	性别 (男/女,n)	年龄(岁)	身高(m)	体质量(kg)	体质量指数 (kg/m²)	摔伤	车祸伤	其他伤
对照组	22	9/13	76.05±5.30	1.64±0.07	63.59±8.43	23.59±1.96	16	5	1
试验组	23	10/13	76.74±4.94	1.62±0.07	62.30±9.08	23.56±1.92	14	7	2
χ²/t值		0.000	-0.454	0.820	0.492	0.052	0.786
P值		1.000	0.652	0.416	0.625	0.958	0.708

组别	n	住院时间(d)	住院费用(元)	骨折临床愈合时间(周)
对照组	22	6.77±1.31	36622.44±3471.80	13.90±1.87
试验组	23	5.34±1.27	34943.30±3825.63	10.86±1.36
t值		3.716	1.540	6.248
P值		0.001	0.131	< 0.001

组别	n	内固定失败	肺部感染	伤口感染	发生率
对照组	22	1	1	1	3(13.6%)
试验组	23	0	0	1	1(4.3%)

组别	n	术前	术后6周	术后3个月	术后6个月
对照组	22	6.09±1.44	3.04±1.09	2.00±1.11	1.63±1.04
试验组	23	6.04±1.46	2.95±1.29	1.56±1.07	1.65±1.02
t值		0.109	0.249	1.330	-0.051
P值		0.913	0.805	0.190	0.959

组别	n	术后6周	术后3个月	术后6个月
对照组	22	48.18±5.11	75.63±3.00	86±3.28
试验组	23	57.78±7.24	77.47±3.80	87±2.67
t值		-5.115	-1.799	-1.611
P值		< 0.001	0.079	0.115

股骨粗隆间骨折术后早期负重在适宜人群中的效果

Effect of Early Weight-bearing on Appropriate Population with Intertrochanteric Fracture after Surgery

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