基于微信平台的健康管理模式在胫骨平台骨折患者术后康复中的应用研究

Application of health management mode based on WeChat platform in postoperative rehabilitation of patients with tibial plateau fractures

目的探讨利用微信平台健康管理模式对胫骨平台骨折(TPF)患者术后康复效果的影响。方法选取2014年1月至2016年12月海军军医大学附属长海医院战创伤急救中心收治的120例TPF患者为研究对象,利用随机数字表法将患者分为微信组及对照组,每组60例。微信组患者应用微信建群模式进行点对点、点对面三维立体式管理;对照组患者实施常规门诊随访指导;两组干预时间均为10个月。对患者远期并发症关节僵硬、创伤性关节炎进行观察和客观评估,数据行χ~2检验。在干预前后分别对两组患者进行Rasmussen临床分级评估,评估内容为功能、疼痛、活动范围、屈曲畸形、肌力、稳定性;并应用骨折术后生活水平调查问卷对两组患者干预前后疾病认知度、治疗重视度、医嘱执行度、日常活动改善情况、焦虑紧张度、术后恢复满意度进行调查评分,数据行t检验。结果微信组患者发生术后远期并发症关节僵硬、创伤性关节炎分别是5、3例,显著少于对照组(12、8例),差异均有统计学意义(χ~2=3.358、2.502,P值均小于0.05)。干预前,两组患者Rasmussen临床分级评分比较差异均无统计学意义(P值均大于0.05);对照组患者干预后Rasmussen临床分级评分高于干预前,差异均有统计学意义(P值均小于0.05);微信组患者干预后Rasmussen临床分级评分中功能、疼痛、活动范围、屈曲畸形、肌力、稳定性的评分分别为(16.89±4.14)、(24.33±4.42)、(13.93±3.12)、(7.17±2.42)、(7.12±2.54)、(7.15±2.59)分];高于干预前[(6.78±2.82)、(5.78±1.87)、(5.84±1.97)、(2.71±1.09)、(2.67±1.02)、(2.45±0.88)分],差异均有统计学意义(t=39.739、19.841、14.462、12.129、20.571、9.676,P值均小于0.05),且高于干预后对照组对应的评分[(12.91±3.12)、(20.76±3.92)、(10.78±2.83)、(5.78±1.82)、(5.65±1.78)、(5.62±1.82)分,差异均有统计学意义(t=4.657、3.199、3.486、2.798、2.049、2.506,P<0.05、=0.003、0.001、0.008、0.047、0.017)。干预前,两组患者生活水平评分比较,差异均无统计学意义(P值均大于0.05);对照组患者干预后生活水平评分低于干预前;微信组患者干预后生活水平评分中疾病认知度、治疗重视度、医嘱执行度、日常活动改善、焦虑紧张度、术后恢复满意度的评分分别为(1.01±0.32)、(0.78±0.22)、(1.12±0.13)、(1.04±0.21)、(0.76±0.12)、(1.06±0.14)分,低于干预前[(3.01±0.82)、(2.89±0.79)、(3.21±0.62)、(2.99±0.71)、(3.21±0.63)、(3.10±0.76)分],差异均有统计学意义(t=15.667、17.899、18.006、11.103、13.516、10.376,P值均小于0.05),且低于干预后对照组的评分[(2.13±0.42)、(1.89±0.62)、(1.89±0.31)、(1.68±0.46)、(1.64±0.33)、(1.88±0.34)分],差异均有统计学意义(t=8.542、5.060、10.376、4.819、5.940、9.000,P值均小于0.05)。结论微信管理对患者实施健康管理具有积极的影响,能够减少术后远期并发症,提高患者膝关节活动功能,并能提高患者生活质量。

Objective To explore the effect of Wechat platform health management on postoperative rehabilitation in patients with tibial plateau fractures（ TPF）. Methods A total of 120 patients with TPF admitted to War-Trauma Emergency Center,Changhai Hospital,Navy Military Medical University from January 2014 to December 2016 were enrolled in this study. Patients were divided into We Chat group and control group with random number table method,60 patients in each group. The We Chat group was used to perform point-to-point and point-to-face three-dimensional stereotactic management using the We Chat grouping model; the control group of the patients who were used for routine outpatient follow-up guidance. The intervention time of two groups both were 10 months. Patients with long-term complications of joint stiffness,traumatic arthritis were observed and objectively evaluated. The data were processed with chi-square test.Before and after intervention,Rasmussen clinical grade score was performed on the two groups of patients. The assessment included function,pain,range of motion,flexion deformity,muscle strength,and stability; disease knowledge, treatment emphasis, executive compliance, daily activity improvement, anxiety stress,postoperative recovery satisfaction were investigated. The data were processed with t test. Results We Chat group patients had long-term postoperative complications of joint stiffness and traumatic arthritis（ 5 and 3 cases）,which were significantly lower than control group（ 12 and 8 cases）（ χ~2= 3. 358,2. 502; with P values below 0. 05）. Before the intervention,there were no significant differences in Rasmussen clinical grade scores between the two groups. Rasmussen clinical grade scores in the control group patients after intervention were higher than those before intervention（ with P values below 0. 05）. The score of functional,pain,range of motion,flexion deformity,muscle strength and stability in Rasmussen clinical grade score of We Chat group patients after intervention were（ 16. 89 ± 4. 14）,（ 24. 33 ± 4. 42）,（ 13. 93 ± 3. 12）,（ 7. 17 ±2. 42）,（ 7. 12 ± 2. 54） and（ 7. 15 ± 2. 59） points respectively,were significantly higher than those before intervention [（ 6. 78 ± 2. 82）,（ 5. 78 ± 1. 87）,（ 5. 84 ± 1. 97）,（ 2. 71 ± 1. 09）,（ 2. 67 ± 1. 02） and（ 2. 45 ±0. 88） points],the differences were statistically significant（ t = 39. 739,19. 841,14. 462,12. 129,20. 571,9. 676; with P values below 0. 05）. The scores were also significantly higher than those after intervention in control group [（ 12. 91 ± 3. 12）,（ 20. 76 ± 3. 92）,（ 10. 78 ± 2. 83）,（ 5. 78 ± 1. 82）,（ 5. 65 ± 1. 78） and（ 5. 62 ± 1. 82） points],the differences were statistically significant（ t = 4. 657,3. 199,3. 486,2. 798,2. 049,2. 506; P〈0. 05,= 0. 003,0. 001,0. 008,0. 047,0. 017）. In addition,before intervention,there were no statistically significant differences in the evaluation of living standards between the two groups. The control group had lower evaluation of living standards after intervention than before intervention. The scores of disease awareness, treatment emphasis, execution order, improvement of daily activities, anxiety and postoperative recovery satisfaction in We Chat group were（ 1. 01 ± 0. 32）,（ 0. 78 ± 0. 22）,（ 1. 12 ± 0. 13）,（ 1. 04 ± 0. 21）,（ 0. 76 ± 0. 12） and（ 1. 06 ± 0. 14） points respectively,were lower than those before intervention [（ 3. 01 ± 0. 82）,（ 2. 89 ± 0. 79）,（ 3. 21 ± 0. 62）,（ 2. 99 ± 0. 71）,（ 3. 21 ± 0. 63） and（ 3. 10 ±0. 76） points],the differences were statistically significant（ t = 15. 667,17. 899,18. 006,11. 103,13. 516,10. 376; with P values below 0. 05）. The scores were also significantly lower than those of the control group after intervention [（ 2. 13 ± 0. 42）,（ 1. 89 ± 0. 62）,（ 1. 89 ± 0. 31）,（ 1. 68 ± 0. 46）,（ 1. 64 ± 0. 33） and（ 1. 88 ±0. 34） points]. The differences were statistically significant（ t = 8. 542,5. 060,10. 376,4. 819,5. 940,9. 000; with P values below 0. 05）. Conclusions We Chat management has a positive impact on health management of patients. It can reduce postoperative long-term complications,improve knee joint function and improve life quality of patients.