胫骨平台(SchatzkerⅤ型)骨折术后康复的临床研究

Clinical study of rehabilitation after operation for tibial plateau fracture (Schatzker Ⅴ)

目的比较胫骨平台SchatzkerⅤ型骨折术后不同时间开始功能康复锻炼对膝关节功能的影响。方法回顾性分析2009年7月—2018年1月于解放军中部战区总医院骨科收治的胫骨平台(SchatzkerⅤ型)骨折患者68例,根据术后开始康复时间不同分成三组,A组18例,男性11例,女性7例;平均年龄(44.7±5.6)岁;B组22例,男性15例,女性7例;平均年龄(44.0±5.2)岁;C组28例,男性19例,女性9例;平均年龄(44.7±4.9)岁。A、B、C组分别于术后2周、1周和当天开始患肢膝关节屈伸锻炼。比较三组膝关节功能、VAS评分、患者护理满意度以及并发症情况。结果随访12个月后,A、B、C组患者膝关节功能比较差异无统计学意义(P>0.05),但三组患者VAS评分组间差异有统计学意义(P<0.001)。两组间比较,随访12个月后,B、C组VAS评分显著低于A组(P<0.05);C组VAS评分显著低于B组(P<0.05);三组组间患者护理满意度差异有统计学意义(P<0.001),且满意度C组>B组>A组;三组患者无手术伤口感染、无复位丢失及内固定松动情况发生,也未发生关节僵硬、创伤性关节炎等并发症。结论胫骨平台SchatzkerⅤ型骨折坚强内固定术后,尽早行患肢功能康复锻炼,并不会对患肢膝关节功能恢复造成不利影响,且患者满意度较高。

Objective To compare the effect of functional rehabilitation exercise on knee joint function in patients with Schatzker V fracture of tibial plateau at different time after operation.Methods A retrospective analysis was made of 68 patients with Schatzker V type tibial plateau fracture treated in our hospital from Jul.2009 to Jan.2018,including 18 in group A(11 males and 7 females aged 44.7±5.6 years),22 in group B(15 males and 7 females aged 44.0±5.2 years)and 28 in group C(19 males and 9 females aged 44.7±4.9 years).Knee flexion and extension exercises were separately started 2 weeks,1 week and the day after operation in group A,B and C group.The knee joint furction,VAS score,nursing satisfacfion and complications were compared.Results After 12 months of follow-up,there was no significant difference in knee function among the three groups(P>0.05).While the VAS scores of the patients in the group were significantly decreased(P<0.05),and VAS scores in group B and C were significantly lower than that in group A(P<0.05)and VAS score in group C was lower than that in group B(P<0.05).The satisfaction of nursing was group C>group B>group A,and there were great differences among the three groups(P<0.05).There was no surgical wound infection,no loss of reset or loose internal fixation or joint stiffness and matic arthritis.Conclusion After strong internal fixation fracture tibia platform Schatzker type,postoperative fracture line of limb function rehabilitation exercise as soon as possible will not cause adverse effect on limb knee function recovery,and patients are more likely to accept.