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

doi:10.3969/j.issn.1006-9771.2022.07.001

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (7): 745-752.doi: 10.3969/j.issn.1006-9771.2022.07.001

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

王宇章^1a,刘晓华^1a,陶莉^1a,李蔷^1a,职文倩^1a,黄强^1a,郭险峰^1a,葛宇峰^1b,王金辉^1b,吴新宝^1b()

1.北京积水潭医院,a. 康复医学科；b. 创伤骨科,北京市100035

收稿日期:2021-12-14 修回日期:2022-03-04 出版日期:2022-07-25 发布日期:2022-08-08
通讯作者: 吴新宝 E-mail:wuxinbao_jst@126.com
作者简介:王宇章(1990-),女,汉族,北京市人,硕士,技师,主要研究方向：骨折术后康复、脊柱术后康复、运动损伤的康复。|吴新宝,男,博士,主任医师。
基金资助:
北京市科学技术委员会京津冀协同创新推动项目(Z171100004517008)

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

WANG Yuzhang^1a,LIU Xiaohua^1a,TAO Li^1a,LI Qiang^1a,ZHI Wenqian^1a,HUANG Qiang^1a,GUO Xianfeng^1a,GE Yufeng^1b,WANG Jinhui^1b,WU Xinbao^1b()

1. a. Department of Rehabilitation Medicine; b. Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China

Received:2021-12-14 Revised:2022-03-04 Published:2022-07-25 Online:2022-08-08
Contact: WU Xinbao E-mail:wuxinbao_jst@126.com
Supported by:
Beijing Municipal Science & Technology Commission Beijing-Tianjin-Hebei Collaborative Innovation Promotion Program(Z171100004517008)

摘要/Abstract

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(χ² > 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。

关键词: 骨科康复, 髋臼骨折, 康复临床路径, 随机对照研究

Abstract:

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 (χ² > 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.

Key words: orthopedic rehabilitation, acetabular fracture, rehabilitation clinical pathway, randomized control trial

中图分类号:

R687.4

王宇章,刘晓华,陶莉,李蔷,职文倩,黄强,郭险峰,葛宇峰,王金辉,吴新宝. 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[J]. 《中国康复理论与实践》, 2022, 28(7): 745-752.

WANG Yuzhang,LIU Xiaohua,TAO Li,LI Qiang,ZHI Wenqian,HUANG Qiang,GUO Xianfeng,GE Yufeng,WANG Jinhui,WU Xinbao. Perioperative rehabilitation clinical pathway of acetabular fracture in light of the integration of orthopedics and rehabilitation: a prospective randomized control trial[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(7): 745-752.

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组别	n	性别 (男/女)/n	年龄/岁	身高/cm	体质量/kg	文化程度(高等教育/非高等教育)/n	工作类型(体力劳动/非体力劳动)/n
对照组	37	26/11	50.4±11.3	170.4±6.8	72.3±10.9	9/28	15/22
试验组	39	33/6	45.1±14.2	172.2±7.1	74.9±12.7	17/22	17/22
χ²/t/Z值		2.25	-1.791	1.076	0.969	3.131	0.072
P值		0.134	0.077	0.285	0.336	0.077	0.788
组别	n	损伤原因(高能量损伤/低能量损伤)/n	髋臼骨折分型(后壁/横断/前柱/双柱/横断伴后壁/后柱伴后壁/T型/后柱)/n		手术复位质量(优/良)/n	术后并发症(无/感染/血栓/贫血)/n	平均住院日(d)
对照组	37	25/12	12/4/2/14/4/0/1/0		33/4	37/0/0/0	10(7,12)
试验组	39	31/8	15/2/4/9/5/3/0/1		33/6	35/1/1/2	10(8,12)
χ²/t/Z值		1.391	7.307		0.063	3.503	-0.235
P值		0.238	0.370		0.802	0.362	0.814

组别	n	术前	出院	术后2周	术后6周	术后12周	术后24周	χ²值	P值
对照组	37	5(4, 6)	2(2, 3)	2(1, 2)	1(0, 1.5)	0(0, 1)	0(0, 0)	158.453	< 0.001
试验组	39	5(4, 7)	2(2, 3)	2(2, 2)	0(0, 1)	0(0, 0)	0(0, 0)	171.965	< 0.001
Z值		-0.333	-0.162	-0.716	-1.926	-1.771	-1.061
P值		0.739	0.872	0.474	0.054	0.077	0.289

组别	n	术前	出院	术后2周	术后6周	术后12周	术后24周	χ²值	P值
对照组	37	20(10, 30)	35(30, 40)	40(35, 50)	65(55, 77.5)	90(77.5, 95)	100(97.5, 100)	177.382	< 0.001
试验组	39	15(10, 25)	40(30, 45)	45(40, 50)	75(70, 90)	100(95, 100)	100(100, 100)	187.204	< 0.001
Z值		-0.860	-2.175	-2.121	-3.163	-3.601	-1.862
P值		0.390	0.030	0.034	0.002	< 0.001	0.063

组别	n	术后2周	术后6周	术后12周	术后24周	χ²值	P值
对照组	37	35(24.5, 44)	55(40, 66)	74(64.5, 86.5)	91(85.5, 100)	111.000	< 0.001
试验组	39	42(33, 53)	67(63, 77)	92(79, 96)	100(100, 100)	117.000	< 0.001
Z值		-2.428	-7.390	-3.532	-4.716
P值		0.015	< 0.001	< 0.001	< 0.001

组别	n	术后6周	术后12周	术后24周	χ²值	P值
对照组	37	0	11	26	5.284	< 0.001
试验组	39	6	26	36	55.846	< 0.001
χ²值		-	10.369	6.136
P值		0.026	0.001	0.013

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

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