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

Abstract

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

CLC Number:

R681.8

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.

Figures/Tables 6

References 26

[1]	Magaziner J, Chiles N, Orwig D. Recovery after hip fracture: interventions and their timing to address deficits and desired outcomes-evidence from the baltimore hip studies[J]. Nestle Nutr Inst Workshop Ser, 2015, 83(1):71-81.
[2]	居家宝, 张培训. 髋部骨折流行病学特点:单中心1397例分析[J]. 实用骨科杂志, 2019, 25(7):592-595.
	Ju J B, Zhang P X. Epidemiological characteristics of hip fracture:a single center analysis of 1397 cases[J]. J Pract Orthop, 2019, 25(7):592-595.
[3]	Rutenberg T F, Vitenberg M, Haviv B, et al. Timing of physiotherapy following fragility hip fracture: delays cost lives[J]. Arch Orthop Trauma Surg, 2018, 138(11):1519-1524. doi: 10.1007/s00402-018-3010-1
[4]	Mereddy P K R, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures[J]. Injury, 2009, 40(4):428-432. doi: 10.1016/j.injury.2008.10.014
[5]	Sadic S, Custovic S, Jasarevuc M, et al. Proximal femoral nail antirotation in treatment of intertrochanteric hip fractures: a retrospective study in 113 patients[J]. Med Arch, 2015, 69(6):352-356. doi: 10.5455/medarh.
[6]	Simmermacher R K J, Ljungqvist J, Bail H, et al. The new proximal femoral nail antirotation (PFNA) in daily practice:results of a multicentre clinical study[J]. Injury, 2008, 39(8):932-939. doi: 10.1016/j.injury.2008.02.005 pmid: 18582887
[7]	曲巧格, 王杰华, 游小军. 转子间骨折固定失效13例临床分析[J]. 中国骨伤, 2009, 22(9):702-703.
	Qu Q G, Wang J H, You X J. Clinical analysis for fixation failure of 13 patients with intertrochanteric fractures[J]. Chin J Orthop Trauma, 2009, 22(9):702-703.
[8]	Wirtz C, Abbassi F, Evangelopoulos D S, et al. High failure rate of trochanteric fracture osteosynjournal with proximal femoral locking compression plate[J]. Injury, 2013, 44(6):751-756. doi: 10.1016/j.injury.2013.02.020 pmid: 23522837
[9]	Haidukewych G J, Israel T A, Berry D J. Reverse obliquity fractures of the intertrochanteric region of the femur[J]. J Bone Joint Surg Am, 2001, 83:643-650. pmid: 11379732
[10]	Carlin L, Sibley K, Jenkinson R, et al. Exploring Canadian surgeons' decisions about postoperative weight bearing for their hip fracture patients[J]. J Eval Clin Pract, 2018, 24:42-47. doi: 10.1111/jep.2018.24.issue-1
[11]	王东, 周君琳. 老年髋部骨折术后早期负重的时机及其影响因素[J]. 中华老年骨科与康复电子杂志, 2017, 3(5):257-259.
	Wang D, Zhou J L. The timing and influence factors of early postoperative weight-bearing in elderly hip fracture parents[J]. Chin J Geriatr Orthop Rehabil (Electronic Edition), 2017, 3(5):257-259.
[12]	胥少汀, 葛宝丰, 卢世壁, 等. 实用骨科学[M]. 4版. 北京: 人民军医出版社, 2019.
	Xu S T, Ge B F, Lu S B, et al. Practocal of Orthopaedics [M]. 4th ed. Beijing: People's Medical Publishing House, 2019.
[13]	Kamel H K, Iqbal M A, Mogallapu R, et al. Time to ambulation after hip fracture surgery: relation to hospitalization outcomes[J]. J Gerontol A Biol Sci Med Sci, 2003, 58(11):1042-1045.
[14]	Terjesen T, Svenningsen S. The effects of function and fixation stiffness on experimental bone healing[J]. Acta Orthop Scand, 1988, 59(6):712-715. pmid: 3213463
[15]	丁真奇, 高俊. 叩击式骨应力刺激仪促进闭合性胫骨干骨折愈合[J]. 临床骨科杂志, 2006, 9(4):289-292.
	Ding Z Q, Gao J. Development of the rap system of stress stimulation and clinical study of the promoting effect on the healing of closed tibia shaft fracture[J]. J Clin Orthop, 2006, 9(4):289-292.
[16]	Zhang P, Malacinski G M, Yokota H. Joint loading modality: its application to bone formation and fracture healing[J]. Br J Sports Med, 2008, 42(7):556-560. doi: 10.1136/bjsm.2007.042556
[17]	Chao E Y S, Inoue N, Elias J J, et al. Enhancement of fracture healing by mechanical and surgical intervention[J]. Clin Orthop Relat Res, 1998, 355S(355):S163-S178. doi: 10.1097/00003086-199810001-00018
[18]	Siu A L, Penrod J D, Boockvar K S, et al. Early ambulation after hip fracture: effects on function and mortality[J]. Arch Intern Med, 2006, 166(7):766-771. doi: 10.1001/archinte.166.7.766
[19]	邱纪方, 李建华, 梁小平, 等. 康复科住院患者功能独立性测量与住院费用和时间的关系[J]. 中华物理医学与康复杂志, 2002, 24(7):391-395.
	Qiu J F, Li J H, Liang X P, et al. The relationship between the admission FIM score and hospital costs and length of stay in neurorehabilitation in parents[J]. Chin J Phys Med Rehabil, 2002, 24(7):391-395.
[20]	Kammerlander C, Pfeufer D, Lisitano L A, et al. Inability of older adult patients with hip fracture to maintain postoperative weight-bearing restrictions[J]. J Bone Joint Surg Am, 2018, 100(11):936-941. doi: 10.2106/JBJS.17.01222 pmid: 29870444
[21]	Ottesen T D, McLynn R P, Galivanche A R, et al. Increased complications in geriatric patients with a fracture of the hip whose postoperative weight-bearing is restricted: an analysis of 4918 patients[J]. Bone Joint J, 2018, 100-b(10):1377-1384.
[22]	Oldmeadow L B, Edwards E R, Kimmel L A, et al. No rest for the wounded: early ambulation after hip surgery accelerates recovery[J]. ANZ J Surg, 2006, 76(7):607-611. pmid: 16813627
[23]	Kubiak E N, Beebe M J, North K, et al. Early weight bearing after lower extremity fractures in adults[J]. J Am Acad Orthop Surg, 2013, 21(12):727-738. doi: 10.5435/JAAOS-21-12-727 pmid: 24292929
[24]	Chilov M N, Cameron I D, March L M. Evidence-based guidelines for fixing broken hips: an update[J]. Med J Aust, 2003, 179(9):489-493. doi: 10.5694/mja2.2003.179.issue-9
[25]	Chang S M, Zhang Y Q, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures[J]. Arch Orthop Trauma Surg, 2015, 135(6):811-818. doi: 10.1007/s00402-015-2206-x
[26]	黄丽花, 李维嫣, 吴家园, 等. 卫生经济学评价方法在临床医学研究中的应用概况[J]. 中国医药指南, 2019, 17(14):58-60.
	Huang L H, Li W Y, Wu J Y, et al. The application of health economics evaluation method in clinical medical research[J]. Guide Chin Med, 2019, 17(14):58-60.

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

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

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