影响桡骨远端骨折中医康复效果的多因素分析

Multivariate Analysis of TCM Rehabilitation Effect of Distal Radius Fractures

目的:探讨影响桡骨远端骨折中医康复效果的相关因素。方法:选取2014年5月至2015年10月在中国中医科学院望京医院门诊就诊的桡骨远端骨折关节功能障碍患者72例,通过中央随机方法分为试验组和对照组各36例,试验组36例,脱落1例,男3例,女32例,平均年龄(61.78±8.61)岁;对照组36例,脱落2例,男7例,女27例,平均年龄(61.64±10.12)岁,最终完成69例。试验组给予中医综合康复治疗,对照组给予中药熏洗+功能锻炼治疗,均治疗3周。以Gartland和Werley腕关节评分、焦虑自评量表、影像数据为评定标准,采集治疗前、治疗3周后的数据进行统计分析。结果:康复介入时间、骨折复位质量、康复方法、焦虑情绪4个因素与腕关节中医康复疗效有相关性,康复方法的选择和焦虑情绪是影响腕关节功能中医康复疗效的独立影响因素。结论:系统完善的中医综合康复指导及治疗对腕关节康复疗效的影响至关重要,而焦虑情绪作为影响腕关节功能康复疗效的独立危险因素,临床医生必须给予足够重视。

Objective： To explore factors affecting the TCM rehabilitation curative effect of distal radius fractures. Methods： From May,2014 to October, 2015,72 patients with distal radius fracture meeting standards were treated using central randomization system for clinical research. All the patients were divided into two groups： test group and control group. 36 patients in test group and 36 in control group. 69 cases were finished treatment and followed up in the end, The test group fall off 1 case, and the control group fall off 2 cases. The test group was given TCM synthetic rehabilitation （manipulative therapy, joint mobilization, soaking-washing with Chinese medicinal herbs, functional exercise）, and the control group was given functional exercise as well as soaking-washing with Chinese medicinal herbs, 3 weeks for both. Three evaluation standards were used in this research,which were Gartland and Werley wrist score, self-rating anxiety scale （SAS） and imaging examination outcomes （the height of radical styloid, angle of ulnar drift, and palmaris inclination）. Before treatment （baseline） and after 3 weeks of treatment were the two points in time when collected the data. Results： Univariate statistical analysis showed that the following four factors, including the time of rehabilitation intervention, the quality of fracture reduction, the traditional rehabilitation method, and the anxiety of patients, all indicated correlations with wrist rehabilitation effect of patients. Furthermore, through binary logistic regression analysis, the selection of rehabilitation methods and the anxiety level in fractures patients were independent factors influencing the rehabilitation effect of wrist joint function. Conclusion ： In the process of distal radius facture rehabilitation, systematical and complete TCM synthetic rehabilitation guidelines and treatment is vital for the effects of rehabilitation, while anxiety is the independent and dangerous factor for the therapy of functional disability of wrist joints after distal radius fractures, clinicians must give adequate attentions in the process of clinical rehabilitation.