老年髋部再骨折术后持续性家庭式康复指导效果观察

Effects observation of continuous rehabilitation guidance on seniors after hip re-fracturing surgery

目的探讨老年髋部再骨折术后持续性家庭式康复指导效果。方法对2008年3月至2013年2月河北港务集团有限公司港口医院骨科收治的39例老年髋部再骨折患者,以入院日期单双日为准,随机分为观察组20例,对照组19例。观察组实施持续性康复指导方案,主要是术后指导患者以康复功能锻炼为中心的持续性康复方案。对照组实施常规康复方案,对患者进行常规健康教育,出院进行门诊随访。分别于患者出院时及出院后1、3、6个月,采用髋关节Harris评分对两组患者髋关节功能进行评定,考量患者对康复知识的掌握,并考察患者术后并发症的发生情况。结果出院时两组患者髋关节功能Harris评分基本接近,出院后1个月观察组Harris评分高于对照组,差异无统计学意义(P>0.05);出院后3、6个月观察组Harris评分(82.13±3.15、90.63±4.46)、康复知识掌握优良率(90.00%、95.00%)分别高于对照组(79.96±1.57、82.74±6.65)、(73.68%、78.94%),差异均有统计学意义(t=2.746、4.433,χ2=6.170、8.576,P均<0.05),在随访康复过程中观察组康复知识掌握优良率呈上升趋势;两组患者均有不同程度并发症发生,深静脉血栓、关节僵硬及失用性萎缩、褥疮等并发症中,观察组患者发生率明显低于对照组。结论对老年髋部再骨折术后患者行持续家庭式康复指导,提高家庭支持力度,可有效提高患者对康复知识的掌握,利于关节功能恢复,减少并发症的发生,有助于提高生活质量和自理能力的恢复。

Objective To explore effects of continuous rehabilitation guidance on seniors after hip re-fracturing surgery. Methods In 2008 March to 2013 February,thirty-nine cases of the author＇s departments were randomly divided into the observation group（20 cases）and control group（19 cases）on the basis of the single and double date of admission. For the observation group,the continuous rehabilitation guidance was implemented,which mainly focused on post-surgery rehabilitative exercise. For the control group,the conventional rehabilitation program was provided. The functioning ability by Harris hip score, occurrence of complications,grasp of rehabilitation knowledge in both observation group and control group were evaluated at the discharge,1 month,3 months and 6 months after discharge. Results Harris hip score at discharge of two groups of patients was approximate,Harris hip score of observation group was higher than＆amp;nbsp;control group＇s,there was no statistically significant difference（P〉 0. 05）Harris hip score and excellent and good rate of rehabilitation knowledge of the observation group（82. 13 ± 3. 15,90. 63 ± 4. 46）,（90. 00% , 95. 00% ）were higher than those of the control group（79. 96 ± 1. 57,82. 74 ± 6. 65）,（73. 68% ,78. 94% ） in the 3 months,6 months after discharge,the difference had statistical significance（t = 2. 746,4. 433,χ^2 = 6. 170,8. 576,P〈 0. 05）. The excellent and good rate of observation group was on the upward trend in the follow-up of the rehabilitation process. The incidence of deep venous thrombosis,joint stiffness and disuse atrophy,bedsore in the observation group was significantly lower than the control group. Conclusions For elderly patients treated by hip re-fracturing surgery,post-surgery continuous family rehabilitation guidance can increase family supports,effectively improve patients＇ grasping of the rehabilitation knowledge, benefit the recovery of hip functions,reduce the occurrence of complication,and it is beneficial to improve life quality and restore self-care ability.