股骨髁间骨折术后患肢采用特殊体位制动加速康复的效果观察

Effect of placing the affected limb in a special posture on enhanced recovery after surgery program for femoral intercondylar fracture

目的:观察股骨髁间骨折行切开复位内固定术后将患肢置于特殊体位制动康复的效果。方法:回顾性分析2017年1月至2019年10月收治的27例股骨髁间骨折患者,均行切开复位内固定治疗。13例患者(对照组)术后患肢膝关节屈曲15°~20°制动3 d,14例患者(观察组)术后患肢膝关节屈曲70°~80°制动2~3 d。记录术后患肢膝关节主动屈曲至120°时的时间,术后1、2、3、6周患肢膝关节疼痛视觉模拟评分法(VAS)评分,术后2周、6周、6个月患肢膝关节美国特种外科医院(HSS)评分,骨折愈合时间,以及术后并发症情况。结果:27例患者随访6~11个月,平均(7.5±0.4)个月。观察组患肢膝关节主动屈曲至120°时的时间早于对照组(P<0.05)。术后1、2、3周观察组VAS评分均低于对照组(P<0.05),但术后6周两组VAS评分比较差异无统计学意义(P>0.05)。术后2周、6周、6个月观察组HHS评分均高于对照组(P<0.05)。两组骨折愈合时间比较差异无统计学意义(P>0.05)。对照组术后出现患肢膝关节僵硬1例,接骨板断裂1例;观察组未出现相关并发症。结论:股骨髁间骨折切开复位内固定术后将患肢膝关节屈曲70°~80°制动2~3 d后行功能锻炼,能促进关节活动度恢复,减轻疼痛及并发症,加速康复。

Objective: To explore the effect of placing the affected limb in a special posture on enhanced recovery after surgery(ERAS) program after open reduction and internal fixation for femoral intercondylar fracture. Methods: A retrospective analysis was performed in 27 patients with femoral intercondylar fracture who were treated by open reduction and internal fixation from January 2017 to October 2019. After the surgery, 13 patients(control group) underwent knee flexion at 15° to 20° for 3 d, and 14 patients(observation group) received knee flexion at 70° to 80° for 2-3 d. The duration from active flexion of the knee to 120° after surgery, visual analogue scale(VAS) score at 1, 2, 3 and 6 weeks after surgery, Hospital for Special Surgery(HSS) score of knee function at 2 weeks, 6weeks and 6 months after surgery, fracture healing time and postoperative complications were recorded. Results: All the patients were followed up for 6-11 months, with an average of(7.5±0.4)months. The time of active flexion to 120° in the observation group was earlier than that in the control group(P<0.05). The VAS score in the observation group were significantly lower than that in the control group at 1, 2 and 3 weeks after operation(P<0.05), but there was no significant difference in the VAS score between the two groups at 6 weeks after operation(P>0.05). The HHS score in the observation group were higher than that in the control group at 2 weeks, 6 weeks and 6 months postoperatively(P<0.05). There was no significant difference in the fracture healing time between the two groups(P>0.05). There was 1 case of knee stiffness and 1 case of plate breaking in the control group, but no complications occurred in the observation group. Conclusions: The knee flexion at 70° to 80° for 2-3 d after open reduction and internal fixation is conducive to the recovery of joint mobility, relieves pain and postoperative complications, and accelerates the recovery of knee joint function in patients with femoral intercondylar fracture.