早期负重锻炼对不稳定性踝关节骨折术后功能恢复及愈合的影响

The influence of early weight bearing exercise on postoperative function and fracture healing of unstable ankle fracture patients

目的观察早期负重锻炼对不稳定性踝关节骨折患者术后功能恢复及骨折愈合的影响。方法选择1999年1月至2010年1月四川省洪雅县中医医院骨伤科接受手术治疗的50例不稳定型踝关节骨折患者，按入院顺序随机分为两组各25例，两组患者术后均口服中药治疗，在此基础上治疗组于术后早期开始负重锻炼，对照组采用术后石膏固定2周后进行功能锻练，比较两组患者术后功能及骨折愈合情况。结果①治疗组踝关节周径差，术后24h为（2．78±0．67）cm，术后1周为（1．67±0．59）cm，与对照组同阶段[分别为（2．81±0．68）cm、（1．69±0．51）cm]比较，差异无统计学意义（P均〉0．05）。术后6周时，治疗组踝关节周径差为（0．53±0．31）cma，明显小于对照组的（1．25±0．47）cm，两组比较差异有统计学意义（f=6．39，P〈0．05）。②治疗组患者治疗6周时肿胀缓解总有效率为96．0％，高于对照组的76．0％，两组比较差异有统计学意义（22=4．15，P〈0．05）。③疼痛指数：两组患者术后24h、术后1周时和术后6周时比较，差异均无统计学意义（t值分别为0．33、0．68、0．28，P均〉0．05）。④治疗组术后3个月Baird．Jackson评分为（73．28±6．11）分，对照组为（71．89±5．92）分，两组比较差异无统计学意义（P〉0．05）；术后6个月时治疗组为（95．21±8．25）分，高于对照组的（82．52±6．96）分，两组比较差异有统计学意义（P〈0．05）。结论早期负重锻炼可促进患肢血液回流，缓解肿胀，有利于不稳定踝关节骨折肢体功能恢复及骨折的愈合。

Objective To compare the influence of early weight bearing exercise and plaster fixed method on postoperative function and fracture healing of unstable ankle fracture patients. Methods 50 cases of unstable ankle fracture patients who did surgical treatment in our hospital were selected as the research object, and were randomly divided into an observation group and a control group. The observation group was applied with early postoperative weight bearing exercise, while the control group patients was applied with postoperative plaster fix with 2 weeks. The postoperative function and fracture healing situation of both groups were compared. Results At postoperative 24 hours and 1 week, the perimeter difference of two groups were not statistically different （P〉 0.05）. At postoperative 6 weeks, the perimeter difference was （0.53± 0.31） cm in the observation group and （1.25±0.47） cm in the control group, the comparative differences was statistical significance （t=6.39, P〈0.05）. The total effective rate of alleviate swelling in the observation group at postoperative 6 weeks was 96.0%, which was higher than that of the control group （76.0%） with statistical difference （x2- 4.15, P〈 0.05）. At postoperative 24 hours, postoperative 1 week and postoperative 6 weeks, the pain index comparison difference between the two groups was not statistically significant （P〉0.05）. The Baird-Jackson score of the observation group at postoperative 3 months was not different with the control group with statistically significant （P〉0.05） ; At the postoperative 6 months, the Baird-Jackson score of the observation group was （95.21 ±8.25）, which was higher than that in the control group （82.52±6.96） with statistical difference （t=5.88, P〈0.05）. Conclusion The early weight bearing exercise can promote haemal circumfluence, relieve swelling, and be helpful for function recovery and fracture healing of unstable ankle fracture patients.