围术期康复干预路径在胫腓骨骨折术后康复的应用

Application of Rapid Rehabilitation Path in Patients with TibiofibularFracture after Operation

目的:通过临床路径管理工具,将胫腓骨骨折患者手术与康复的治疗流程进行衔接,并观察临床疗效.方法:选择2017年7月-2018年12月符合单纯性胫腓骨骨折诊断的出院患者63例作为研究对象,分为手术-康复路径组(观察组)和对照组,其中对照组按常规腰硬联合麻醉下的胫腓骨骨折切开复位内固定手术流程治疗;观察组在对照组的基础上,在术后早期加入患肢无痛性活动、被动性牵拉、局部物理照射等康复治疗内容,对比并分析2组患者的患肢疼痛情况的改善程度、关节活动度恢复时间、关节功能恢复程度、并发症发生情况.结果:观察组术后第14天视觉模拟评分为(2.70±0.77)分,较对照组(3.37±1.27)天较低0.67分(P<0.05);关节功能恢复时间为(93.74±6.96)天,较对照组(116.40±5.80)天降低22.66天(P<0.05);术后24周关节功能恢复的优良率为83.33%,较对照组60.61%升高22.72%(P<0.05);2组患者均未见伤口愈合延迟、肺部感染、深静脉血栓等术后并发症发生.结论:手术-康复一体化治疗可以有效降低胫腓骨骨折患者的术后疼痛程度,缩短肢体功能恢复时间,提高恢复程度.

Objective:Through the clinical pathway management tools,the tibia and fibula fracture patients with surgery and rehabilita-tion of the treatment process,and observe the clinical efficacy.Methods:Sixty-three discharged patients with simple tibiofibular fracture diagnosed from July 2017 to December 2018 were divided into two groups:operation-rehabilitation path group and control group.The control group was treated with open reduction and internal fixation of tibiofibular fracture under combined spinal-epidural anesthesia;the operation-rehabilitation path group was the basis of the control group.On the other hand,early rehabilitation treatment such as painless activity,passive traction and local physical irradiation was added after operation.The improvement degree of limb pain,recovery time of joint activity,recovery degree of joint function and complications of the two groups were compared and analyzed.Results:On the 14th day after operation,the visual analogue score was 2.70 and 0.67(P<0.05);lower than that of the control group at 3.37 days,and the re-covery time of joint function was 93.74 days,22.66 days lower than that of the control group at 116.40days(P<0.05);the excellent and good rate of joint function recovery at 24 weeks after operation was 83.33%,which was 60.6%lower than that of the control group.1%increased by 22.72%(P<0.05);no complications such as delayed wound healing,pulmonary infection,deep venous thrombosis oc-curred in both groups.Conclusion:Rapid rehabilitation pathway can effectively reduce the degree of pain,shorten the recovery time of limb function and strengthen the recovery degree of adjacent ankle and knee joint function in patients with tibia and fibula fracture after op-eration.