骨折联络服务在老年半月板损伤患者术后康复中的应用

Application of fracture liaison service-based intervention in elderly patients with meniscus injury

目的探讨骨折联络服务(FLS)对老年半月板损伤患者术后膝关节功能和衰弱的影响,为临床康复提供参考。方法选择2018年2月至2019年10月在西安交通大学第二附属医院完成手术治疗的老年半月板损伤患者86例,按照随机数字表法分为试验组和对照组,每组43例,对照组给予常规术后护理和康复,试验组在对照组基础上实施基于FLS的护理干预。以膝关节功能、膝关节活动度以及衰弱程度作为评价指标,比较2组患者的康复效果。结果最终试验组纳入38例,对照组纳入41例。2组患者出院时膝关节功能、膝关节活动度以及衰弱程度比较差异无统计学意义(P>0.05)。出院1、3个月,试验组患者膝关节功能评分和膝关节活动度分别为(75.37±4.68)、(90.34±3.02)分和(96.68±8.11)°、(119.11±7.92)°,高于对照组的(73.17±3.92)、(87.76±2.93)分和(91.76±7.75)°、(108.61±7.72)°,差异有统计学意义(t值为2.26~5.96,均P<0.05)。2组患者膝关节功能评分、膝关节活动度随时间变化而变化(F=264.33、279.54,均P<0.05);2组患者膝关节活动度存在组间和时间的交互效应(F=6.12,P<0.05)。出院1、3、6个月,试验组患者生理维度得分和衰弱总分分别为(5.08±1.34)、(4.74±1.10)、(4.13±0.88)分和(8.32±1.50)、(7.82±1.31)、(6.82±0.95)分,低于对照组的(5.68±1.15)、(5.22±0.85)、(5.02±0.76)分和(9.05±1.28)、(8.40±0.89)、(8.18±0.90)分,差异有统计学意义(t值为2.15~6.57,均P<0.05);出院6个月,试验组患者心理、认知维度得分(0.98±0.30)、(0.45±0.24)分,低于对照组的(1.32±0.37)、(0.59±0.22)分,差异有统计学意义(t=4.49、2.82,均P<0.05)。2组患者生理、认知维度得分及衰弱总分随时间变化而变化(F=30.61、31.72、38.50,均P<0.05);2组患者生理维度得分及衰弱总分存在组间和时间的交互效应(F=2.86、4.03,均P<0.05)。结论基于FLS的护理干预可促进老年半月板损伤患者术后康复,改善患者衰弱程度。

Objective To investigate the intervention effects of fracture liaison service(FLS)-based intervention in elderly patients with meniscus injury,to provide reference for clinical rehabilitation.Methods A total of 86 elderly patients with meniscus injury from February 2018 to October 2019 in the Second Affiliated Hospital of Xi′an Jiaotong University were divided into experimental group and control group according to random number table method.There were 43 cases in each group.The control group was given routine nursing,and the experimental group implemented FLS-based nursing intervention on the basis of the control group.The clinical effects were compared between the two groups by using knee function,knee joint mobility and degree of frailty.Results Finally,38 cases were included in the experimental group and 41 cases in the control group.There was no significant difference in knee function,knee joint mobility and degree of frailty between the two groups at discharge(P>0.05).At 1,3 months after discharge,the knee scores and knee joint mobility were(75.37±4.68)points,(90.34±3.02)points and(96.68±8.11)°,(119.11±7.92)°in the experimental group,higher than those in the control group(73.17±3.92)points,(87.76±2.93)points and(91.76±7.75)°,(108.61±7.72)°,the differences were statistically significant(t values were 2.26-5.96,all P<0.05).The knee function scores and knee joint mobility of the two groups changed with time(F=264.33,279.54,both P<0.05).There were interaction effects between groups and time in the knee joint mobility of the two groups(F=6.12,P<0.05).At 1,3,6 months after discharge,the physiological dimension scores and frailty total scores were 5.08±1.34,4.74±1.10,4.13±0.88 and 8.32±1.50,7.82±1.31,6.82±0.95 in the experimental group,lower than those in the control group 5.68±1.15,5.22±0.85,5.02±0.76,9.05±1.28,8.40±0.89,8.18±0.90,the differences were statistically significant(t values were 2.15-6.57,all P<0.05).At 6 months after discharge,the psychological and cognitive dimension scores were 0.98±0.30 and 0.45±0.24 in the experimental group,lower than those in the control group 1.32±0.37 and 0.59±0.22,the differences were statistically significant(t=4.49,2.82,both P<0.05).The physiological and cognitive dimension scores and total scores of the two groups changed with time(F=30.61,31.72,38.50,all P<0.05).There were interaction effects between groups and time in the physiological demension scores and the frailty total scores of the two groups(F=2.86,4.03,both P<0.05).Conclusions FLS-based intervention can promote the rehabilitation of knee joint function and alleviate the degree of frailty of elderly patients with meniscus injury.