中西医综合护理对儿童尺偏型肱骨髁上骨折术后恢复的影响

Effect of integrated nursing intervention on postoperative recovery of supracondylar humerus fractures with ulnar deviation in children

目的 观察中西医综合护理对儿童尺偏型肱骨髁上骨折术后恢复的影响.方法 纳入2015年11月至2016年2月收治的儿童尺偏型肱骨髁上骨折术后患者52例,入组前2组均采用手法整复加小夹板内固定的方法进行治疗,3~4周后拆除外固定后入组,采用随机数字表法分为观察组和对照组,每组26例,其中,观察组进行中西医综合护理干预,对照组进行常规护理;术后4周护理干预结束后依据《中医骨伤科病证诊断疗效标准》对2组疗效进行评价,采用Flynn评分对肘关节的功能进行评价;术后8周行随访并采用《儿童生命质量简化量表》对其生命质量进行评价.结果 在干预过程中,观察组有1例脱落,对照组有3例脱落,故最终观察组有25例,对照组有23例.术后4周观察组治愈15例,好转7例,未愈3例,对照组分别为8、6、9例,2组患者疗效比较差异有统计学意义（Z=-2.120,P=0.034）.术后4周观察组患者Flynn评分优10例,良6例,中6例,差3例,对照组分别为5、4、5、9例,2组比较差异有统计学意义（Z=-2.051,P=0.040）.观察组术后并发症发生率为8.0%（2/25）,对照为30.4%（7/23）,2组比较差异有统计学意义（χ2=2.622,P=0.047）.观察组患者术后8周生命质量在生理、心理、社会以及环境领域得分分别为（77.84±12.15）、（81.13±15.72）、（79.95±20.68）、（79.44±11.57）分,对照组分别为（63.31±15.86）、（63.07±12.63）、（65.65±18.51）、（61.32±17.24）分,2组比较差异均有统计学意义（t=2.516~4.363,P〈0.05）.结论 结合中药熏洗、中医康复指导的中西医综合护理可以较为明显地改善儿童尺偏型肱骨髁上骨折术后患者的肘关节功能,且效果显著优于常规护理方法,具有进一步临床研究与推广应用的价值.

Objective To observe the effect of comprehensive nursing of traditional Chinese medicine and Western Medicine on children′s supracondylar humerus fracture of ulnar deviation on postoperative recovery. Methods From November 2015 to February 2016, 52 inpatients were divided into 2 groups by random digits table method after the external fixation removal surgery with 26 cases each. The observation group was intervened by integrated nursing and was given TCM rehabilitation guidance, while the control group was intervened by regular nursing and was given regular rehabilitation guidance. After 4 weeks, the therapeutic effect was evaluated according to Chinese Medicine Orthopedic Syndrome Diagnosis and their elbow joint function was evaluated by Flynn score. In 8 weeks of follow up, all the patients were valued by their quality of life. Results In the process of intervention, with 1 case fell off in the observation group, 3 cases fell off in the control group, so finally the observation group with 25 cases, the control group with 23 cases. Fifteen cases were cured, 7 cases were improved, 3 cases were not cured at 4 weeks after surgery in the observation group, 8, 6, 9 cases in the control group, and the difference was statistically significant （Z=-2.120, P=0.034）. At 4 weeks after surgery, 10, 6, 6, 3 cases were excellent, good, medium and poor evaluated by Flynn score in the observation group, 5, 4, 5, 9 cases in the control group, and the difference was statistically significant （Z=-2.051, P=0.040）. Incidence of postoperative complications was 8.0% （2/25） in the observation group, 30.4% （7/23） in the control group, and the difference was statistically significant （χ2=2.622, P=0.047）. Physical, psychological, social and environmental fields of quality of life were 77.84 ± 12.15, 81.13 ± 15.72, 79.95 ± 20.68, 79.44 ± 11.57 in the observation group, 63.31 ± 15.86, 63.07 ± 12.63, 65.65 ± 18.51, 61.32 ± 17.24 in the control group, and the difference was statistically significant （t=2.516- 4.363, P〈0.05）. Conclusions Integrated nursing intervention with TCM rehabilitation guidance is a method which can effectively help in improving the elbow movement function and the life quality of children with supracondylar humerus fractures of ulnar deviation.