医疗康复对四肢骨不连地震伤员生活质量的影响

The quality of life of earthquake victims with nonunion fracture in limbs after medical rehabilitation

目的分析医疗康复对四肢骨不连地震伤员生活质量的影响，为今后同类伤员的处理提供依据。方法利用简明健康调查问卷（SF-36量表）评估四川绵竹31例四肢骨不连伤员术前2周、术后3个月、6个月及12个月的生理及心理健康，并与当地正常人群比较；多元线性回归分析影响生理及心理健康恢复的因素。结果①术前所有伤员生理及心理健康评分均显著低于正常人群值（P〈0．01），术后3个月综合评分显著提高（P〈0．05），6个月时进一步改善（P〈0．01），12个月仍有改善，但仍低于正常人群值（P〈0．05）；②与生理健康恢复密切相关的因素是外固定术、吸烟及慢性病，决定系数R2=0．472（P〈0．05）；③与心理健康恢复密切相关的因素是高龄、有家庭成员伤亡、新房未建及低收入，R2=0．450（P〈0．05）。结论医疗康复可显著改善四肢骨不连地震伤员生活质量；灾难后提供医疗康复的同时，应重视社会因素对伤员功能的影响。

Objective To analyze factors contributing to the quality of life of earthquake victims with nonunion fracture in limbs after medical rehabilitation and to provide a clinical reference for future disasters. Methods Thirty-one wounded who sustained their injuries in the Sichuan earthquake completed the short form-36 （SF-36） questionnaire 2 weeks before their amputation, and after 3, 6 and 12 months of medical rehabilitation. The SF-36 scores were compared with Sichuan population norms. Stepwise multiple linear regression was used to highlight varia- bles which influenced their functional recovery and their physical and mental health. Results The physical and mental health composite scores of the 31 victims were significantly lower than Sichuan population norms before medical rehabilitation, but they had a significant increasing trend after 3, 6 and 12 months of treatment. Their scores on all the domains remained significantly lower than Sichuan population norms at a later follow-up. Smoking, external fixations and chronic diseases were related to their recovery of physical function. Age, permanent housing, family income and casualties among family members were related to their mental health recovery. Conclusion The quality of life of patients with nonunion fracture caused by earthquake can be improved significantly through medical rehabilitation. But social factors should be considered in addition to medical rehabilitation after an earthquake.