改良后足部防压疮矫形器在骨科的应用效果分析

Clinical Application of Modified Foot Orthosis for Preventing Pressure Ulcers

目的比较改良后足部防压疮矫形器与传统丁字防旋鞋在脊髓损伤并不全瘫患者预防压疮、足下垂的临床应用效果。方法选择2011年3月—2013年2月入住南昌大学第三附属医院骨科的94例脊髓损伤并不全瘫患者,根据入院日期单双号将患者分为对照组53例和观察组41例,对照组使用传统丁字防旋鞋护理方法,观察组采用改良后足部防压疮矫形器护理,在患者住院第10天和出院后1个月随访,对比两组患者足部压疮、足下垂发生情况。结果住院第10天对照组患者发生压疮4例(7.5%),其中Ⅰ期压疮3例、Ⅱ期压疮1例,未发生足下垂;观察组患者均未发生压疮和足下垂,两组压疮发生率比较差异有统计学意义(P=0.096)。出院后1个月对照组患者发生压疮9例(17.0%),其中Ⅰ期压疮5例、Ⅱ期压疮3例、Ⅲ期压疮1例,发生轻度足下垂6例(11.3%);观察组患者发生压疮1例(2.4%),为Ⅰ期压疮,未发生足下垂,两组压疮发生率及足下垂发生率比较差异均有统计学意义(P值分别为0.019和0.028)。结论改良后足部矫形器预防压疮、足下垂效果明显,因实用、廉价,适用于临床及居家护理。

Objective To compare the modified foot orthosis and traditional T - shaped anti - rotation shoes in terms of the effects of preventing pressure ulcers and foot drop in patients with spinal cord injury and incomplete paralysis. Methods 94 patients with spinal cord injury and incomplete paralysis admitted to the third affiliated hospital of Nanchang University from March 2011 to February 2013 were recruited. According to odd or even number of registered day, 53 cases were divided into control group and 41 cases into observation group. The control group used traditional T - shaped anti - rotation shoes, while the observa- tion group used modified foot orthosis. All patients were followed up on the 10th day in hospital and one month after dis- charge. Results On the 10th day in hospital, 4 cases （7.5%） had pressure ulcer in the control group, including 3 cases in stage Ⅰ and one case in stage Ⅱ , and no foot drop occurred. No pressure ulcer and foot drop occurred in the observation group. The incidence of pressure ulcer between the two groups showed statistically significant difference （ P = 0. 096）. One month after discharge, 9 cases （ 17.0% ） had pressure ulcer in the control group, including 5 cases in stage Ⅰ , 3 cases in stage Ⅱ , and one case in stage Ⅲ. 6 cases （ 11.3% ） in the control group had foot drop. One case （2. 4% ） had pressure ulcer in the ob- servation group, all in stage I, and no foot drop occurred. The incidence of pressure ulcer and foot drop between the two groups both showed statistically significant differences （ P = 0. 019, 0. 028） . Conclusion Modified foot orthosis can effectively prevent pressure ulcers and foot drop. Besides, it is also practical and cheap, which is suitable for clinical nursing and home health care.