当前位置: 首页>博士论文>资源详情
膝关节周围骨折围手术期一体化康复及功能转归相关因素
中文摘要

目的:1.评估不同康复治疗模式对膝关节周围骨折患者切开复位内固定手术围手术期康复的干预效果。2.探究并分析膝关节周围骨折术后患者关节功能预后的相关因素。 方法: 1.本研究为前瞻性队列研究,纳入北京九家综合医院2013年01月至2015年12月因膝关节周围骨折行切开复位内固定手术的患者共668例,分为实验组和对照组。实验组患者执行骨科康复一体化康复治疗模式,康复医师、治疗师、护理人员与骨科医师共同介入膝关节周围骨折患者的围手术期康复。对照组患者执行现行骨科康复治疗模式,仅由手术医师及骨科护理人员向患者提供术后康复指导。术前采集一般情况及手术情况,术后第3-5天评定疼痛量表、下肢关节活动度,术后12周、24周评定疼痛量表、下肢关节活动度、Berg平衡量表(Berg Balance Scale,BBS)、美国特种外科医院膝关节评分(Hospital for Special Surgery Knee Score,HSS),记录骨折愈合情况及术后并发症情况。应用SPSS V20.0对两组的一般情况、手术情况、疼痛量表、下肢关节活动度、Berg平衡量表、HSS膝关节功能评分进行单因素分析。 2.纳入北京九家综合医院因膝关节周围骨折行切开复位内固定手术的患者共668例,于术后12周、24周评定HSS膝关节功能评分。以术后HSS膝关节功能评分为结局指标,分为优和非优两组,对患者的年龄、性别、骨折部位、骨折分型、术前患者临床一般情况、术中出血量、关节面复位质量、骨折稳定性、是否行骨科康复一体化康复治疗模式、有无术后并发症10个因素行单因素分析,再对单因素分析中有统计学意义的因素以及单因素分析中无显著相关性,但临床认为有意义的因素使用多元logistic回归分析。 结果: 1.共纳入患者668例,其中实验组380例,对照组288例。实验组与对照组在年龄、身高、体重、性别比例、手术情况方面差异无统计学意义;实验组与对照组在BMI及学历的差异有统计学意义;实验组疼痛评分在术后12周、术后24周低于对照组,差异有统计学意义;实验组膝关节屈曲活动度在术后第3-5天、术后12周、术后24周明显优于对照组,差异有统计学意义;实验组Berg平衡量表评分在术后12周、术后24周显著高于对照组,差异有统计学意义;实验组HSS膝关节功能评分在术后12周显著性高于对照组,但在术后24周两组差异不具有统计学意义;实验组与对照组在骨折愈合、术后并发症方面差异无统计学意义。 2.使用多元logistic回归分析,骨折部位、是否行骨科康复一体化康复治疗模式是膝关节周围骨折患者术后12周膝关节功能的独立影响因素;骨折部位、术前患者临床一般情况、关节面复位质量、骨折分型是膝关节周围骨折患者术后24周膝关节功能的独立影响因素。 结论: 1.与无康复专业人员参与的现行骨科康复治疗模式相比,围手术期骨科康复一体化模式可以更有效促进膝关节功能康复,并且骨科康复一体化康复治疗模式不影响安全性,适合临床推广成为膝关节周围骨折患者围手术期康复治疗模式。 2.是否行骨科康复一体化康复治疗模式、骨折部位、术前患者临床一般情况、关节面复位质量、骨折分型是膝关节周围骨折患者术后膝关节功能的独立影响因素。可以将骨折部位、术前患者临床一般情况、关节面复位质量、骨折分型作为膝关节骨折患者术后的膝关节功能预后的影响因素。 关键词:[膝关节周围骨折],[切开复位内固定],[骨科康复],[一体化康复治疗模式], [多因素分析]

英文摘要

Objective:To evaluate the effect of different rehabilitation modelon the perioperative rehabilitation of knee fracture patients undergoing open reduction and internal fixation of the knee joint. And to analyze the prognosis of postoperative knee fractures patients. Method: 1.A prospective cohort study was performed on 668 patients undergoing internal fixation surgery between January 2013 and December 2013 in the nine different general hospital in Beijing. Patients are divided into trail group(380) and control group(288). The trail group received rehabilitation in team approach, which is the early access to full rehabilitation involving rehabilitational doctor, physical therapist, surgeons and nurses, the control group received conventional rehabilitation therapy. Patient demographics and managements were collected preoperatively. Primary outcome values were visual analogue scale (VAS) and range of motion in postoperative day 3 to day 5, the 12th week and 24th week. Range of motion, Berg Balance scale (BBS) and Hospital for Special Surgery Knee Score (HSS) in postoperative the 12th week and 24th week. We also recorded postoperative complications and results of fracture healing. 2.Atotal of 668 postoperative knee fracture patients were evaluated in the 12th week and 24th week using HSS knee joint function scale. Patients are divided into Group 1 and Group 2 based on the HSS score. In each group, patients’ age, sex, fracture sites, fracture type, preoperative condition, blood loss during surgery, articular surface reduction quality, stability, rehabilitation in team approach and comorbidity were further evaluated as single prognosis factors using unconditioned logistic regression method. Result: 1.There was no significant difference between the two groups in age, height, weight, sex ratio and surgery. There was significant difference between the two groups in BMI and education background. The VAS of the trail group was significantly lower than the control group in postoperative the 12th week and 24th week. The knee flexion range of motion of the trail group was significantly better than the control group in postoperative day 3 to day 5, the 12th week and 24th week.. The score of Berg balance scale of the trail group was significantly higher than that of the control group after 12 weeks and 24 weeks after surgery. The functional score of HSS knee joint in the trail group was significantly higher than the control group at 12 weeks after the operation, but the difference between the two groups was not statistically significant at 24 weeks after surgery. There was no significant difference in fracture healing and postoperative complications between the two groups. 2.Fracture site and whether rehabilitation in team approach are used postoperatively were independent factors to the function of knee joint in 12 weeks after surgery. Fracture site, preoperative condition, articular surface reduction quality and fracture type are independent factors to the function of knee joint in 24 weeks after surgery. Conclusion: 1.Compared to control group, trail group was shown to experience decreased postoperative pain, better joint function and better rehabilitation results. It’s recommend to utilize the rehabilitation in team approach as the primary postoperative rehabilitation method. 2.Fracturesite and whether rehabilitation in team approach are used postoperatively are independent prognostic factors for joint function in postoperative week 12 , with rehabilitation in team approach and patellar fracture hold more favorable prognosis. Fracture site, baseline demographic, articular surface reduction quality and fracture type are independent prognostic factors for joint function in postoperative week 24, with patella fracture, better preoperative health status , fracture anatomical reduction. AO type hold more favorable prognosis. KEY WORDS: [Knee joint fracture], [Open reduction internal fixation operation],[Orthopedic rehabilitation],[Rehabilitation in team approac],[Multivariate analyses]

作者相关
主题相关
看过该书的人还在看哪些书