老年转子间骨折术后早期功能锻炼的效果研究

Effect of early weight-bearing exercise after surgery on intertrochanteric fractures in the elderly

目的探讨老年转子间骨折内固定术后早期负重功能锻炼对于患者病情恢复的影响。方法收集2015年2月—8月50例年龄≥65岁、采用股骨近端髓内钉治疗的不稳定股骨转子间骨折患者(AO 31-A2或A3)的临床资料,其中25例术后进行早期负重功能锻炼(观察组),25例术后进行常规恢复(对照组)。收集患者的人口统计学数据、改良巴氏评分、欧洲五维健康量表评分;术后1年电话随访评估病死率。结果观察组受伤前、术后48 h内、术后6周、术后12周、术后1年改良巴氏评分分别为(49.56±2.00)、(26.40±3.11)、(44.04±3.92)、(47.92±3.13)、(48.76±3.07)分,对照组分别为(49.92±0.40)、(26.52±3.34)、(40.92±2.62)、(45.44±2.36)、(49.16±1.75)分,观察组在术后6、12周时改良巴氏评分明显优于对照组,两组差异有统计学意义(P<0.05);受伤前、术后48 h内、术后1年两组改良巴氏评分差异无统计学意义(P>0.05)。两组术后1年生存率均为100%。结论老年髋部骨折内固定术后早期负重功能锻炼对于患者术后恢复具有正向的影响。

Objective To explore the effect of early weight-bearing exercise on the recovery of elderly patients with intertrochanteric fractures after internal fixation. Methods The clinical data of 50 patients with unstable intertrochanteric fractures（AO 31-A2 or A3） who underwent proximal femoral nail treatment between February and August 2015 were collected. Among them, 25 patients underwent early weight-bearing exercise after surgery（the observation group）, and 25 patients underwent routine recovery after surgery（the control group）. Demographic data of patients, modified Barthel Index, and Euro QOL Five Dimensions Questionnaire（EQ-5 D） scores were collected, and mortality was assessed by telephone follow-up one year after surgery. Results In the observation group, the modified Barthel Index before injury, within 48 hours, 6 weeks, 12 weeks, and 1 year after surgery was 49.56±2.00, 26.40±3.11,44.04±3.92, 47.92±3.13, and 48.76±3.07, respectively; in the control group, the modified Barthel Index at the above mentioned time points was 49.92±0.40, 26.52±3.34, 40.92±2.62, 45.44±2.36, and 49.16±1.75, respectively. The difference between the observation group and the control group at 6 and 12 weeks after surgery was a statistically significant（P〈0.05）, and the observation group was better than the control group; there was no statistical difference between the two groups in the modified Barthel Index before surgery, within 48 hours after surgery or one year after surgery（P〉0.05）.None of the patients died within the first one year after surgery. Conclusion The early weight-bearing exercise after hip fracture in the elderly has a positive effect on the recovery of the patients.