术后负重锻炼时间对老年股骨颈骨折内固定术后康复的影响

Influence of Time of Weight-bearing Exercise on Rehabilitation after Internal Fixation of Femoral Neck Fracture in Elderly Patients

目的观察老年股骨颈骨折内固定术后早期负重锻炼对患者术后康复的影响。方法选取石家庄市人民医院2018年7月—2019年7月收治的60例GardenⅠ、Ⅱ型行闭合复位空心螺钉内固定术的老年股骨颈骨折患者,根据术后开始负重锻炼时间的不同均分为观察组和对照组。观察组为术后48 h即指导患者扶双拐行患肢部分负重锻炼,至术后1个月扶单拐行部分负重锻炼,至术后2个月撤去辅助拐行完全负重锻炼;对照组术后避免患肢负重,直至术后3个月才行完全负重锻炼。比较两组术后3 d下肢深静脉血栓形成、肺感染发生率,术前及术后3、6、12个月血清一氧化氮(NO)和肿瘤坏死因子-α(TNF-α)水平变化,术后12个月股骨头坏死、骨折不愈合内固定失效、股骨颈短缩、股骨颈前倾角度、髋关节Harris评分及其优良率和视觉模拟评分法(visual analogue scale,VAS)评分差异。结果术后3 d,观察组下肢深静脉血栓形成发生率、肺感染率均明显低于对照组(P<0.05);术后12个月观察组骨折不愈合内固定失效与股骨头坏死发生率均低于对照组(P<0.05);对照组术后3个月、6个月及12个月血清NO及TNF-α水平较观察组明显增高(P<0.05);术后12个月两组股骨颈短缩与前倾角度变化率比较差异均无统计学意义(P>0.05);术后12个月观察组Harris评分、Harris评分优良率及VAS评分均优于对照组(P<0.05)。结论在专业指导下行患肢早期阶段性负重锻炼可有效降低老年股骨颈骨折内固定患者术后下肢深静脉血栓形成、肺感染、股骨头坏死、骨折不愈合内固定失效等并发症发生率,且不增加股骨颈短缩及股骨颈前倾角度改变发生率,并可明显改善术后髋关节功能,减轻术后疼痛,加快术后康复。

Objective To observe the effect of early weight-bearing exercise on postoperative rehabilitation of elderly patients with femoral neck fracture after internal fixation.Methods Sixty elderly patients with femoral neck fracture undergoing GardenⅠ,Ⅱclosed reduction and the hollow screw fixation between July 2018 and July 2019 in the People's Hospital of Shijiazhuang were entered into this study.According to different time of postoperative weight-bearing exercise,they were divided into observation group and control group.In the observation group,at 48 h after the operation,the patients were instructed to carry out partial weight-bearing exercise on the affected limb by holding both crutches,to carry out partial weight-bearing exercise on the single crutches at 1 month after the operation,and to remove the assistance for complete weight-bearing exercise on the crutches at 2 months after the operation.The control group avoided weight-bearing until 3 months after the operation.The incidence of deep vein thrombosis(DVT)of lower extremities at 3 d after operation,incidence of pulmonary infection,changes of serum nitric oxide(NO)and tumor necrosis factor-α(TNF-α)levels preoperatively and postoperatively,femoral head necrosis at 12 months after the operation,fracture non-unions and internal fixation failure,shortening of the femoral neck,femoral neck anteversion(FNA)angle,the Harris hip score,excellent and good rate,and visual analogue scale(VAS)score were compared between the two groups.Results At 3 d after operation,the incidence of DVT of lower extremities and pulmonary infection rate in the observation group were significantly lower than those in the control group(P<0.05).The incidence of fracture nonunion and internal fixation failure and rate of femoral head necrosis in the observation group was lower than that in the control group at 12 months after operation(P<0.05).Serum levels of NO and TNF-αwere significantly higher in the control group at 3,6 and 12 months after operation than in the observation group(P<0.05).There was no significant difference in the change rates of femoral neck shortening and FNA angle between the two groups at 12 months after operation(P>0.05).The Harris score,excellent and good rate of Harris score and VAS score were higher in the observation group than in the control group at 12 months after operation(P<0.05).Conclusion Early-stage weight-bearing exercise of the affected limb under professional guidance can effectively reduce the incidence of complications,including DVT of lower extremities,pulmonary infection,femoral head necrosis,fracture non-unions and internal fixation failure,and does not increase the incidence of shortening of the femoral neck and changes of FNA angle in elderly patients undergoing internal fixation for femoral neck fracture.In addition,it can significantly improve postoperative hip joint function,reduce postoperative pain,and accelerate the postoperative recovery.