踝关节骨折术后早期功能练习与支具保护对术后功能恢复的比较研究

Comparative study of early functional exercise and brace protection on functional recovery after ankle fracture surgery

目的探究踝关节骨折术后早期功能练习与支具保护对术后功能恢复的比较。方法回顾性分析北京市大兴区中西医结合医院2016年3月至2021年3月收治的踝关节骨折的患者98例,按照不同的康复治疗方式分组,其中对照组48例,术后由康复医师指导踝关节背伸、跖屈等功能练习。观察组50例,术后前4周采用支具保护,4周后采用同对照组一样的功能练习,两组6周后均进行部分负重活动。比较两组患者的早期活动时间和骨折愈合时间,观察两组患者治疗前,治疗3、6、9、12个月美国足与踝关节协会评分(AOFAS)和健康状况简易调查表(SF-36)评分以及患者踝关节评分。结果观察组患者的早期活动时间晚于对照组,骨折愈合时间短于对照组,差异有统计学意义(P<0.05)。术后治疗3个月时观察组患者的AOFAS评分和SF-36评分以及患者踝关节评分均显著优于对照组,差异有统计学意义(P<0.05)。在治疗前和术后治疗6、9、12个月,两组患者的AOFAS评分、SF-36评分以及患者踝关节评分比较,差异无统计学意义(P>0.05)。结论踝关节骨折术后采用支具保护,其早期功能恢复比早期直接采用功能练习的效果差,但6个月后两者功能恢复无明显差异,且踝关节骨折术后早期制动有利于骨折恢复,可以充分保护和稳定踝关节,提升患者的生活质量。

Objective To study the effect of early functional exercise and brace protection on functional recovery after ankle fracture surgery.Methods A retrospective analysis of 98 patients with ankle fractures in Beijing Daxing District Hospital of Integrated Chinese and Western Medicine from March 2016 to March 2021 was performed.The patients were grouped according to different rehabilitation treatments,including 48 cases in the control group and 50 cases in the observation group.Patients in the control group were instructed by rehabilitation physicians to perform functional exercises such as ankle dorsiflexion and plantar flexion after operation.Patients in the observation group were protected by braces in the first 4 weeks after operation,and performed the same functional exercises as those in the control group after 4 weeks.After 6 weeks,both of the two groups underwent partial weight-bearing activities.Time to resume early activity and time to fracture healing of the two groups were compared.The scores of American orthopedic foot and ankle society(AOFAS)and MOS 36-Item Short-Form Health Survey(SF-36)as well as the ankle score of the two groups of patients before treatment and at 3,6,9 and 12 months after treatment were observed.Results Time to resume early activity of patients in the observation group was later than that of patients in the control group,and time to fracture healing was shorter than that of patients in the control group,with statistically significant differences(P<0.05).Three months after treatment,the AOFAS and SF-36 scores as well as the ankle score of the observation group were significantly better than those of the control group,with statistically significant differences(P<0.05).There were no statistically significant differences in AOFAS,SF-36 and ankle scores between the two groups before treatment and at 6,9,and 12 months after treatment(P>0.05).Conclusion The effect of brace protection is worse than early direct functional exercise on early functional recovery after ankle fracture surgery,but there is no significant difference in functional recovery after six months.Besides,early immobilization after ankle fracture surgery is conducive to fracture recovery,which can fully protect and stabilize the ankle to improve the quality of life of patients.