耐受负重训练提高老年股骨粗隆间骨折患者术后的早期活动能力

Weight bearing as tolerated improves early mobility after intertrochanteric fracture in the elderly

目的对比研究耐受负重和部分负重对老年股骨粗隆间骨折患者术后的早期康复疗效。方法选取2018年7月至2020年1月,在厦门大学附属东南医院骨科诊断为AO/OTA分型31A1型股骨粗隆间骨折并行股骨近端防旋髓内钉(PFNA)内固定术的49例患者,随机分成对照组(n=25)和试验组(n=24),对照组用电子秤限制患肢<20 kg的范围内行部分负重,试验组控制患肢疼痛视觉模拟评分(VAS)≤3分的范围内行耐受负重,两组均在术后48 h内负重,负重频率为10 min/次、3次/d。出院当天评估两组的站立行走计时测试(TUG)、帕克活动能力评分(PPMS)、疼痛视觉模拟评分(VAS),出院当天和术后3个月并发症发生情况、Harris髋关节评分,并比较两组的住院周期。结果与对照组对比,试验组的TUG更短(P<0.001),住院周期更短(P<0.05),术后PPMS更高(P<0.001),骨折前和术后的PPMS差值更少(P<0.001)。两组的术前、术后VAS疼痛评分差异均无统计学意义(均P>0.05)。出院当天两组均未发生并发症,术后3个月对照组出现2例并发症(1例内固定失败和1例伤口感染),试验组出现1例内固定失败的并发症,但两组差异无统计学意义(P>0.05)。出院当天harris评分两组比较差异无统计学意义(P>0.05),但术后3个月试验组harris评分明显高于对照组(P<0.05)。结论AO/OTA分型31A1型股骨粗隆间骨折PFNA内固定术后,且骨折复位符合内侧皮质中性支撑的老年患者于术后48 h内开始耐受负重可在不增加患肢疼痛和并发症,且住院周期相对较短的同时获得更好的早期活动能力,且后期的髋关节功能更好。

Objective To compare the early rehabilitation effect of tolerated weight bearing and partial weight bearing on elderly patients with intertrochanteric fracture.Methods From July 2018 to January 2020,49 elderly patients with AO/OTA type 31A1 intertrochanteric fracture of femur underwent proximal antirotation intramedullary nail(PFNA)internal fixation and fracture reduction in line with medial cortical neutral support in Dongnan Hospital of Xiamen University were randomly divided into control group(n=25)and experimental group(n=24).The control group was given partial weight bearing within the range of the affected limb<20 kg by electronic scale,while the experimental group was given tolerance weight bearing within the range of visual analogue score(VAS)≤3 points.Both groups were given weight bearing within 48 h after surgery,and the weight bearing frequency was 10 min/time and 3 times/day.On the day of discharge,the two groups were assessed on the standing and walking timing test(TUG),Parker Mobility Score(PPMS),Visual analogue scale pain score(VAS),complications on the day of discharge and 3 months after surgery,and Harris hip score,and the length of hospitalization between the two groups was compared.Results Compared with the control group,the experimental group had shorter TUG(P<0.001),shorter hospitalization period(P<0.05),higher postoperative PPMS(P<0.001),and less difference in PPMS before and after fracture(P<0.001).There was no statistically significant difference in preoperative and postoperative VAS pain scores between the two groups(P>0.05).During discharge,no complications occurred in both groups.3 months after surgery,2 complications occurred in the control group,including 1 case of internal fixation failure and 1 case of wound infection,and 1 case of internal fixation failure occurred in the experimental group,but there was no statistical significance between the two groups(P>0.05).There was no significant difference in harris score between the two groups on the day of discharge(P>0.05),and harris score of the experimental group was significantly higher than that of the control group three months after surgery,with statistical difference(P<0.05).Conclusions Elderly patients with AO/OTA type 31A1 intertrochanteric fracture of femur with PFNA internal fixation and fracture reduction in line with medial cortical neutral support who begin to tolerate weight bearing within 48 h after the operation can achieve better early mobility and later hip function without increased pain and complications of the affected limb and with a relatively short hospital stay.