【摘要】：目的:分析不同理念指導(dǎo)下的康復(fù)功能鍛煉應(yīng)用于股骨粗隆間骨折術(shù)后對(duì)患者功能康復(fù)的促進(jìn)效果,并證實(shí)“動(dòng)靜平衡”原則與AO無痛原則下自主練習(xí)這兩種不同理念指導(dǎo)下股骨粗隆間骨折PFNA術(shù)后髖關(guān)節(jié)功能康復(fù)的臨床效果是否有差異,為患者的術(shù)后功能康復(fù)提供一種更系統(tǒng)、更有效的方法。方法:病例選擇成都市青白江區(qū)人民醫(yī)院骨外科2014年6月至2016年6月期間收治的72例股骨粗隆間骨折PFNA內(nèi)固定患者,對(duì)72例患者進(jìn)行隨機(jī)分組,劃分為研究組與對(duì)照組,兩組各36例。研究組36例股骨粗隆間骨折PFNA內(nèi)固定患者在“動(dòng)靜平衡”原則下指導(dǎo)進(jìn)行康復(fù)功能鍛煉,研究組36例患者中,19例男性患者,17例女性患者;年齡在60-89歲范圍內(nèi),其中8例患者的年齡在60-69歲范圍內(nèi),20例患者的年齡在70-79歲范圍內(nèi),8例患者的年齡在80-89歲范圍內(nèi);致傷原因:2例墜落傷,25例摔傷,9例交通事故傷;股骨粗隆間骨折AO分型:7例A1型,20例A2型,9例A3型。對(duì)照組36例股骨粗隆間骨折PFNA內(nèi)固定患者在AO無痛原則下自主進(jìn)行康復(fù)功能鍛煉,對(duì)照組36例患者中,20例男性患者,16例女性患者;年齡在60-89歲范圍內(nèi),其中9例患者的年齡在60-69歲范圍內(nèi),21例患者的年齡在70-79歲范圍內(nèi),6例患者的年齡在80-89歲范圍內(nèi);致傷原因:6例墜落傷,20例摔傷,10例交通事故傷;股骨粗隆間骨折AO分型:10例A1型,21例A2型,5例A3型。對(duì)比兩組股骨粗隆間骨折PFNA內(nèi)固定患者的髖關(guān)節(jié)Harris評(píng)分、髖關(guān)節(jié)活動(dòng)優(yōu)良率與術(shù)后并發(fā)癥發(fā)生率,判斷兩組患者術(shù)后康復(fù)鍛煉的效果。結(jié)果:研究組36例股骨粗隆間骨折PFNA內(nèi)固定患者的Harris評(píng)分、髖關(guān)節(jié)活動(dòng)優(yōu)良率分別為(91.34±6.87)分、88.89%,對(duì)照組36例股骨粗隆間骨折PFNA內(nèi)固定患者的Harris評(píng)分、髖關(guān)節(jié)活動(dòng)優(yōu)良率分別為(79.18±11.69)、66.67%,與對(duì)照組相比較而言,研究組36例股骨粗隆間骨折PFNA內(nèi)固定患者的髖關(guān)節(jié)活動(dòng)優(yōu)良率明顯更高;且與對(duì)照組相比較而言,研究組36例股骨粗隆間骨折PFNA內(nèi)固定患者的肌肉肌腱軟組織粘連、關(guān)節(jié)僵硬等并發(fā)癥的發(fā)生率明顯更低。兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:“動(dòng)靜平衡”理念指導(dǎo)下股骨粗隆間骨折PFNA內(nèi)固定術(shù)后康復(fù)鍛煉的效果明顯優(yōu)于AO無痛原則下患者自主進(jìn)行功能鍛煉,有利于進(jìn)一步促進(jìn)股骨粗隆間骨折PFNA內(nèi)固定患者的髖關(guān)節(jié)功能恢復(fù),能夠在很大程度上降低一系列術(shù)后并發(fā)癥發(fā)生率,提高患者生存質(zhì)量,“動(dòng)靜平衡”理念指導(dǎo)下股骨粗隆間骨折PFNA術(shù)后康復(fù)鍛煉是一種安全、簡(jiǎn)單且有效的快速康復(fù)方法,值得在臨床一線醫(yī)護(hù)工作中推廣運(yùn)用。
[Abstract]:Objective: to analyze the effect of rehabilitation exercise guided by different ideas on the functional rehabilitation of patients with intertrochanteric fracture of femur. It was also confirmed that there were differences in the clinical effects of hip joint function rehabilitation after PFNA operation between the principle of "static balance" and the principle of AO painless self-exercise under the guidance of the two different concepts of hip joint function rehabilitation after PFNA operation for intertrochanteric fracture of femur. To provide a more systematic and effective method for postoperative functional rehabilitation. Methods: from June 2014 to June 2016, 72 patients with intertrochanteric fracture treated by PFNA were randomly divided into study group and control group. There were 36 cases in each group. In the study group, 36 patients with PFNA internal fixation of intertrochanteric fracture underwent rehabilitation exercise under the principle of "dynamic balance". In the study group, there were 19 male patients and 17 female patients. The age ranged from 60 to 89 years, of which 8 patients were within the age range of 60-69 years, 20 patients were within the age range of 70-79 years, and 8 patients were within the age range of 80-89 years. AO classification of femoral intertrochanteric fracture: 7 cases were type A1, 20 cases were type A2, 9 cases were type A3. In the control group, 36 patients with intertrochanteric fracture of femur were treated with PFNA internal fixation under the principle of painless AO. In the control group, 20 cases were male and 16 cases were female. The age ranged from 60 to 89 years, of which 9 patients were within the age range of 60-69 years, 21 patients were within the age range of 70-79 years, and 6 patients were within the age range of 80-89 years. AO classification of femoral intertrochanteric fracture: A1 type in 10 cases, A2 type in 21 cases, A3 type in 5 cases. The Harris score of hip joint, the excellent and good rate of hip joint movement and the incidence of postoperative complications were compared between the two groups of patients with intertrochanteric fracture with PFNA. Results: in the study group, the Harris scores of 36 patients with intertrochanteric fracture of femur and the excellent and good rate of hip motion were (91.34 鹵6.87) and 88.89, respectively. The Harris scores of 36 cases of PFNA internal fixation of intertrochanteric fracture of femur in the control group were evaluated. The excellent and good rates of hip motion were (79.18 鹵11.69) and 66.67, respectively. Compared with the control group, 36 patients with intertrochanteric fracture in the study group had higher excellent and good rate of hip motion than those in the control group. Compared with the control group, the incidence of muscle tendon soft tissue adhesion and joint stiffness in 36 patients with intertrochanteric fracture treated with PFNA in the study group was significantly lower than that in the control group. The difference between the two groups was statistically significant (P0.05). Conclusion: under the guidance of the idea of "dynamic balance", the effect of rehabilitation exercise after PFNA internal fixation of femoral intertrochanteric fracture is obviously better than that of AO without pain. It is helpful to further promote the recovery of hip joint function in patients with intertrochanteric fracture treated with PFNA, reduce a series of postoperative complications, and improve the quality of life of patients with intertrochanteric fracture. The idea of "static and dynamic balance" is a safe, simple and effective method for rapid rehabilitation of intertrochanteric fracture after PFNA, which is worth popularizing in clinical first-line medical work.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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