肘关节骨折患者康复模式的前瞻性多中心研究

A prospective multicenter study on the rehabilitation pattern for post-surgery patients with the elbow fracture

目的探讨肘关节骨折术后采用不同康复模式的治疗效果,提出适宜的肘关节骨折术后早期康复模式。方法在9家医院因肘关节骨折129例行手术治疗后的患者作为研究对象,采用队列研究方法,分为对照组和观察组。对照组采用现行骨科康复模式,观察组采用骨科康复一体化模式进行术后康复。分别在术后5天、12周、24周进行视觉模拟评分(visual analague scale,VAS)、关节活动度评定,术后12周、24周进行HSS(hospital for special surgery)功能评定。结果 VAS评分观察组:术后5天(3.94±2.12)分,术后12周(1.04±1.46)分,术后24周(0.38±0.76)分;对照组:术后5天(3.12±1.54)分,术后12周(1.12±1.28)分,术后24周(0.75±1.12)分,差异无统计学意义(P>0.05)。主动屈曲和伸直活动度观察组:屈曲术后5天(72.07±28.08)°,术后12周(107.55±24.11)°,术后24周(120.40±22.56)°;伸直术后5天(18.97±18.68)°,术后12周(15.59±17.51)°,术后24周(10.51±14.66)°;对照组(屈曲术后5天(68.24±28.29)°,术后12周(107.50±20.64)°,术后24周(117.82±18.66)°;伸直术后5天(17.54±25.34)°,术后12周(18.24±22.43)°,术后24周(14.27±23.99)°,差异无统计学意义(P>0.05)。前臂旋前和旋后术后5天及术后12周时观察组:旋前术后5天(51.50±30.95)°,术后12周(77.76±13.23)°;旋后术后5天(47.00±30.92)°,术后12周(77.14±15.67)°;对照组:旋前术后5天(42.22±29.67)°,术后12周(74.55±18.52)°;旋后术后5天(41.50±30.31)°,术后12周(71.98±21.99)°,差异无统计学意义(P>0.05);术后24周时观察组旋前(83.06±7.41)°,旋后(82.77±7.65)°,显著优于对照组旋前(78.30±14.59)°,旋后(73.56±22.67)°(P=0.035,P=0.005)。HSS评分术后12周观察组(77.00±15.06)分,对照组(68.14±19.35)分,差异无统计学意义(P>0.05);术后24周HSS评分观察组(89.73±9.17)分,显著优于对照组(78.57±20.39)分(P=0.015)。结论骨科康复一体化模式不增加肘关节骨折术后患者的疼痛,并能够更好地改善肘关节骨折术后患者功能指标,适合作为肘关节骨折术后早期康复模式。

Objective To evaluate the outcomes of different rehabilitation patterns for patients who have undergone a surgery for elbow fracture, and to put forward a suitable rehabilitation pattern for post-surgery patients with the elbow fracture. Methods A total of 129 cases receiving surgery for the elbow fracture in 9 hospitals in Beijing were divided into two groups：（ 1） the control group： received common orthopedic rehabilitation;（ 2） the observation group： received post-surgery rehabilitation in team approach. Visual analogue scale（ VAS） and range of motion（ ROM） were assessed 5 days, 12 weeks and 24 weeks after the surgery. The hospital for special surgery score（ HSS） was assessed 12 weeks and 24 weeks after the surgery. Results There were no statistically significant differences in VAS（ the observation group at 5 days, 12 weeks and 24 weeks after the surgery were 3.94 ± 2.12, 1.04 ± 1.46 and 0.38 ± 0.76; the control group at 5 days, 12 weeks and 24 weeks after the surgery were 3.12 ± 1.54, 1.12 ± 1.28 and 0.75 ± 1.12）, flexion（ the observation group at 5 days, 12 weeks and 24 weeks after the surgery were（ 72.07 ± 28.08） °,（ 107.55 ± 24.11） ° and（ 120.40 ± 22.56） °; the control group at 5 days, 12 weeks and 24 weeks after the surgery were（ 68.24 ± 28.29） °,（ 107.50 ± 20.64） ° and（ 117.82 ± 18.66） °, and extension [ the observation group at 5 days, 12 weeks and 24 weeks after the surgery were（ 18.97 ± 18.68） °,（ 15.59 ± 17.51） ° and（ 10.51 ± 14.66） °; the control group at 5 days, 12 weeks and 24 weeks after the surgery were（ 17.54 ± 25.34） °,（ 18.24 ± 22.43） ° and（ 14.27 ± 23.99） ° ]（ P〉 0.05）. The forearm pronation： the observation group 5 days and 12 weeks after the surgery were（ 51.50 ± 30.95） ° and（ 77.76 ± 13.23） °; the control group 5 days and 12 weeks after the surgery were（ 42.22 ± 29.67） ° and（ 74.55 ± 18.52） °. The supination： the observation group 5 days and 12 weeks after the surgery were（ 47.00 ± 30.92） ° and（ 77.14 ± 15.67） °; the control group 5 days and 12 weeks after the surgery were（ 41.50 ± 30.31） ° and（ 71.98 ± 21.99） °. No significant differences existed（ P〉 0.05）. The observation group showed significantly better rotation in the rage of motion（ ROM） 24 weeks after the surgery [ the pronation and supination of the observation group were（ 83.06 ± 7.41） ° and（ 82.77 ± 7.65） °; the pronation and supination of control group were（ 78.30 ± 14.59） ° and（ 73.56 ± 22.67） ° ]（ P = 0.035, P = 0.005）. HSS 12 weeks after the operation： the observation group（ 77.00 ± 15.06） points and the control group（ 68.14 ± 19.35） points; no statistical significance（ P〉 0.05）. HSS 24 weeks after the operation： the observation group（ 89.73 ± 9.17） points and the control group（ 78.57 ± 20.39） points; the observation group was superior to the control group（ P = 0.015）. Conclusions The rehabilitation in team approach improves functions than common orthopedic rehabilitation. It is suitable for early post-surgery rehabilitation of the elbow fracture.