持续被动活动结合阶段性康复锻炼对老年股骨颈骨折术后康复的影响

Effect of continuous passive activity combined with phased rehabilitation exercise on postoperative rehabilitation of elderly patients with femoral neck fractures

目的观察持续被动活动治疗仪结合阶段性康复锻炼对老年股骨颈骨折患者术后康复情况的影响。方法前瞻性选取2022年1月至2023年3月南阳医学高等专科学校第一附属医院收治的113例老年股骨颈骨折患者作为研究对象。采用电脑随机分组法生成随机序列,并进行分配隐藏后,将患者分为锻炼组(56例)和联合组(57例)。锻炼组男33例,女23例;年龄65~75(70.25±5.42)岁;病程7~14(10.24±2.33)d;Garden骨折分型:Ⅱ型30例,Ⅲ型26例。联合组男34例,女23例;年龄67~73(70.36±5.33)岁;病程8~13(10.32±2.19)d;Garden骨折分型:Ⅱ型32例,Ⅲ型25例。所有患者均实施手术治疗,术后锻炼组采用阶段性康复锻炼,联合组采用持续被动活动治疗仪结合阶段性康复锻炼。两组均治疗1个月,治疗结束后随访1年。比较两组髋关节活动度(屈曲、后伸、外旋、内收)、髋关节功能[Harris髋关节评分系统(HHS)、视觉模拟评分法(VAS)]、股静脉血流参数[血流峰值速度(Vp)、血流平均速度(Va)、血流量(BF)、血流阻力指数(RI)]。采用独立样本t检验、配对t检验和χ^(2)检验。结果治疗后,联合组髋关节屈曲[(80.33±10.45)°]、后伸[(12.33±3.25)°]、外旋[(33.49±5.41)°]、内收[(50.23±10.45)°]活动度均大于锻炼组[(75.29±10.41)°、(10.39±2.44)°、(30.25±5.28)°、(45.22±10.36)°](均P<0.05)。随访第6个月和第12个月,联合组HHS评分[(73.35±10.25)分、(82.49±10.44)分]均高于锻炼组[(68.42±10.44)分、(77.69±10.36)分],VAS评分[(4.33±1.25)分、(2.28±0.46)分]均低于锻炼组[(5.29±1.36)分、(3.36±0.45)分](均P<0.05)。治疗后,联合组股静脉Vp[(70.23±10.44)cm/s]、Va[(45.33±10.26)cm/s]均高于锻炼组[(65.44±10.28)cm/s、(40.29±10.36)cm/s],BF[(0.75±0.16)L/min]、RI[(1.33±0.72)kPa/s]均低于锻炼组[(1.25±0.46)L/min、(1.62±0.41)kPa/s](均P<0.05)。结论持续被动活动治疗仪结合阶段性康复锻炼可改善老年股骨颈骨折患者术后髋关节活动度和功能,对促进患者股静脉血流恢复有积极意义。

Objective To observe the effect of continuous passive activity therapy combined with phased rehabilitation exercise on postoperative rehabilitation of elderly patients with femoral neck fractures.Methods A total of 113 elderly patients with femoral neck fractures admitted to the First Affiliated Hospital of Nanyang Medical College from January 2022 to March 2023 were prospectively selected as the study objects.The patients were divided into an exercise group(56 cases)and a combined group(57 cases)after the random sequence was generated by computer randomization method and assigned to hide.There were 33 males and 23 females in the exercise group,aged 65-75(70.25±5.42)years,the course of disease was 7-14(10.24±2.33)d,and the Garden fracture type was type Ⅱ in 30 cases and type Ⅲ in 26 cases.There were 34 males and 23 females in the combined group,aged 67-73(70.36±5.33)years,the course of disease was 8-13(10.32±2.19)days,and the Garden fracture type was type Ⅱ in 32 cases and type Ⅲ in 25 cases.All patients underwent surgical treatment.The exercise group received phased rehabilitation exercise after surgery,and the combined group received continuous passive activity therapy combined with phased rehabilitation exercise.Both groups were treated for 1 month and followed up for 1 year after treatment.The range of hip joint motion(flexion,extension,external rotation,and adduction),hip joint function[Harris Hip Score(HHS)and Visual Analogue Scale(VAS)],femoral vein blood flow parameters[peak flow velocity(Vp),mean flow velocity(Va),blood flow(BF),and flow resistance index(RI)]were compared between the two groups.Independent sample t test,paired t test,andχ^(2)test were used.Results After treatment,the motion ranges of hip joint flexion[(80.33±10.45)°],extension[(12.33±3.25)°],external rotation[(33.49±5.41)°],and adduction[(50.23±10.45)°]in the combined group were greater than those in the exercise group[(75.29±10.41)°,(10.39±2.44)°,(30.25±5.28)°,and(45.22±10.36)°](all P<0.05).The HHS scores[(73.35±10.25)points and(82.49±10.44)points]in the combined group were higher than those in the exercise group[(68.42±10.44)points and(77.69±10.36)points]after 6 and 12 months of follow-up,and the VAS scores[(4.33±1.25)points and(2.28±0.46)points]were lower than those in the exercise group[(5.29±1.36)points and(3.36±0.45)points](all P<0.05).After treatment,the Vp[(70.23±10.44)cm/s]and Va[(45.33±10.26)cm/s]of femoral vein in the combined group were higher than those in the exercise group[(65.44±10.28)cm/s and(40.29±10.36)cm/s],and the BF[(0.75±0.16)L/min]and RI[(1.33±0.72)kPa/s]were lower than those in the exercise group[(1.25±0.46)L/min and(1.62±0.41)kPa/s](all P<0.05).Conclusion Continuous passive activity therapy combined with phased rehabilitation exercise can improve the range of hip joint motion and hip joint function in elderly patients with femoral neck fractures after operation,and has positive significance in promoting the recovery of femoral vein blood flow.