股骨粗隆间骨折PFNA内固定术后康复早期臀中肌针对性训练的意义

Significance of targeted training of gluteus medius in early postoperative rehabilitation after PFNA for intertrochanteric fracture

目的观察股骨粗隆间骨折股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定术后康复早期臀中肌针对性训练对患者运动康复的影响。方法收集住院康复治疗的单侧股骨粗隆间骨折闭合复位PFNA内固定术后患者18例,其中男6例,女12例,平均年龄(69.52±4.37)岁。采用随机数字表将患者分为对照组9例,实验组9例。对照组患者行股骨粗隆间骨折术后常规康复,实验组在常规康复基础上于术后第1周至术后第16周行针对性臀中肌肌力训练、运动控制训练和运动模式训练。治疗后分别对两组患者行患侧颈干角与股骨偏心距测量、臀中肌肌力测定、髋关节Harris评分和体格检查。结果治疗后两组患者患侧颈干角和股骨偏心距比较差异无统计学意义(P>0.05);与对照组相比,实验组经臀中肌针对性训练后,患者患侧臀中肌峰值肌力提升明显(P<0.01),髋关节Harris评分优良率明显提高(P<0.05),Trendelenburg征阳性发生率和运动控制及稳定性问题发生率显著降低(P<0.05),差异均具有统计学意义。结论PFNA内固定术后早期针对性臀中肌训练对维持髋关节力学平衡,减轻髋部疼痛、改善步态和髋关节功能的正常发挥具有至关重要的作用,对提高手术治疗效果和患者生活质量具有重要的临床意义。

Objective To observe the effect of targeted training of gluteus medius muscle on motor recovery of patients with intertrochanteric fracture in early postoperative rehabilitation after proximal femoral nail antirotation(PFNA).Methods Eighteen patients,including 6 males and 12 females,with an average age of(69.52±4.37)years old,were collected after the closed reduction and PFNA internal fixation of unilateral intertrochanteric fractures treated in hospital.The patients were divided into control group(9 cases)and experimental group(9 cases)by random number table method.Patients in the control group received routine postoperative rehabilitation for intertrochanteric fractures,while patients in the experimental group received targeted gluteal muscle strength training,exercise control training and exercise mode training from 1 week to 16 weeks after the operation on the basis of routine rehabilitation.After treatment,measurement of the cervical trunk angle and femoral eccentricity on the affected side,measurement of gluteus medius muscle strength,Harris score of the hip joint and physical examination were performed in the two groups.Results After treatment,there was no statistically significant difference between the two groups in the cervical trunk angle and femoral eccentricity of the affected side(P>0.05).Compared with the control group,after targeted training of gluteus medius muscle in the experimental group,the peak muscle strength of the gluteus medius muscle in the affected side of the patients was significantly improved(P<0.01),the excellent and good rates of Harris score of the hip joint were significantly increased(P<0.05),the positive incidence of Trendelenburg sign and the incidence of movement control and stability problems was significantly reduced(P<0.05),and the differences were statistically significant.Conclusion Targeted gluteus medius muscle training in the early stage after PFNA surgery plays a vital role in maintaining the mechanical balance of the hip joint,reducing hip pain,improving gait and normal functioning of the hip joint,and has important clinical significance in improving surgical treatment effect and patients'quality of life.