微信随访对老年肱骨近端骨折术后肩关节功能的短期影响

Short-term effect of WeChat follow-up on postoperative recovery of shouldeRjoint function in elderly patients with proximal humerus fractures

目的探讨微信随访对老年肱骨近端骨折(proximal humeral fracture,PHF)术后肩关节功能恢复的影响。方法回顾性分析2018年1月—2021年12月重庆市江北区中医院收治的152例老年PHF患者资料,男性55例,女性97例;年龄60~85岁,平均73.2岁。跌倒伤81例,高处坠落伤39例,道路交通伤20例,其他伤12例。根据院外随访方式不同分为微信随访组(73例)和电话随访组(79例)。两组患者均为每周随访1次,前者由具有主治医师职称的医师进行微信视频随访,主要进行视频演示、康复训练纠正答疑、目标制定及知识推送等;后者由具有主管护师职称的专职人员进行电话随访,主要进行告知注意事项、电话答疑、督促门诊随访等。比较围术期临床资料;于术前、术后3个月,采用视觉模拟评分(visual analogue scale,VAS)评估患者肩关节活动时的疼痛情况;Constant-Murley肩关节评分评估患者肩关节活动功能;术后3个月门诊随访时采用量角器测量肩关节的活动度。结果两组患者年龄、性别比例、体质量指数、骨折Neer分型、手术时间、术中出血量和住院天数等资料比较差异均无统计学意义(P>0.05)。两组患者术前VAS[(7.1±2.3)分vs.(7.3±2.6)分]和Constant-Murley评分[(53.6±8.9)分vs.(55.1±9.3)分]比较差异无统计学意义(P>0.05)。术后3个月微信随访组的VAS(1.9±0.6)分显著低于电话随访组(3.2±0.9)分,且Constant-Murley评分微信随访组显著高于电话随访组[(85.3±7.5)分vs.(79.1±10.2)分],差异均有统计学意义(P<0.05)。术后3个月微信随访组肩关节的前屈[(153.6±15.9)°vs.(118.7±17.4)°]、外展[(133.2±12.8)°vs.(106.4±17.1)°]、外旋角度[(76.5±8.7)°vs.(58.6±7.4)°]较电话随访组均显著改善,差异均有统计学意义(P<0.05)。结论针对老年PHF患者术后院外随访,微信较传统电话指导更能提高患者康复锻炼的自我效能,更利于促进肩关节功能恢复。

Objective To investigate the effect of WeChat follow-up on the postoperative recovery of shouldeRjoint function in elderly patients with proximal humeral fractures(PHFs).Methods A retrospective analysis was performed on 152 elderly patients with PHFs admitted to ouRhospital from Jan.2018 to Dec.2021,including 55 males and 97 females aged 60-85 years,mean 73.2 years.The causes of injuries were falls in 81 cases,falls from heights in 39,road traffic injuries in 20,and others in 12.Patients were divided into WeChat follow-up group(n=73)and telephone follow-up group(n=79).All patients were followed up once a week.The formeRwas followed up by an attending physician via WeChat video,mainly focusing on video demonstrations and correction of rehabilitation training exercises,rehabilitation goal setting,related healthy information push,etc.;the latteRwas followed up by a nurse-in-charge,who telephoned patients to remind them about precautions,answeRquestions and supervise regulaRoutpatient follow-ups.Perioperative parameters were recorded.Before and 3 months afteRsurgery,the pain during shouldeRjoint movement was evaluated by visual analogue scale(VAS),and the shouldeRjoint function was assessed by Constant-Murley score.At 3 months outpatient follow-up,the range of motion of the shouldeRjoint was measured using a protractor.Results Age,gendeRdistribution,body mass index,NeeRclassification,operation time,intraoperative bleeding and length of hospitalization stay showed no significant difference between the two groups(all P>0.05),neitheRdid the preoperative VAS(7.1±2.3 vs.7.3±2.6)noRthe Constant-Murley score(53.6±8.9 vs.55.1±9.3,both P>0.05).At 3 months afteRsurgery,the WeChat follow-up group showed significantly loweRVAS score(1.9±0.6 vs.3.2±0.9),improved Constant-Murley score(85.3±7.5 vs.79.1±10.2),and betteRrange of motion,i.e.angle of flexion(153.6°±15.9°vs.118.7°±17.4°),abduction(133.2°±12.8°vs.106.4°±17.1°)and external rotation(76.5°±8.7°vs.58.6±7.4°)of the shouldeRjoint,compared with telephone follow-up group(all P<0.05).Conclusion FoRelderly patients with PHFs,the out-of-hospital follow-up by WeChat can improve the self-efficacy of patients’rehabilitation exercises and is more conducive to promoting recovery of shouldeRjoint function,compared with traditional telephone guidance.