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

Abstract

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

CLC Number:

R687.4

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.

Figures/Tables 5

References 41

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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

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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