专题:抗衰老与老年健康

中医综合康复在老年转子间骨折术后的应用

  • 魏鹏轶 ,
  • 乔钢 ,
  • 邵玮 ,
  • 崔玮佳 ,
  • 冯兆峰 ,
  • 谷亚彤 ,
  • 张瑜
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  • 河北省体育科学研究所, 石家庄 050011
魏鹏轶,主治医师,研究方向为骨科临床诊疗,中医骨伤康复,电子信箱:13780348873@163.com;乔钢(通信作者),副主任医师,研究方向为骨科临床诊疗,中医综合康复,电子信箱:qiaogang_007@163.com

收稿日期: 2024-01-19

  修回日期: 2024-07-06

  网络出版日期: 2024-12-26

Application value of Chinese medicine comprehensive rehabilitation in postoperative recovery of elderly patients with intertrochanteric fractures surgery

  • WEI Pengyi ,
  • QIAO Gang ,
  • SHAO Wei ,
  • CUI Weijia ,
  • FENG Zhaofeng ,
  • GU Yatong ,
  • ZHANG Yu
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  • Hebei Institute of Sport Science, Shijiazhuang 050011, China

Received date: 2024-01-19

  Revised date: 2024-07-06

  Online published: 2024-12-26

摘要

老年转子间骨折的致死率高、预后差。通过研究中医综合康复对老年转子间骨折术后并发症、康复进度,远期预后的影响,旨在明确其在老年转子间骨折术后的临床价值。围手术期康复指标包括初次自主下地时间、引流量、疼痛的视觉模拟量表(VAS)评分、双侧大腿围度差值,远期预后康复评定指标包括髋关节功能的Harris评分、日常生活自理能力(ADL)评分。结果显示中医组的初次下地时间、术后引流总量、术后1周及出院日患肢的VAS、双侧大腿围度差值均显著低于对照组,术后1个月中医组的Harris评分及ADL评分,术后3个月中医组的ADL评分均显著高于对照组,总体并发症发生率显著低于对照组。说明中医综合康复可显著降低骨折术后围手术期的隐性失血、降低患者水肿程度、降低患肢疼痛程度,促进患者的早期功能恢复,具有加快术后髋关节功能恢复、提高预后患者整体生活质量的作用。

本文引用格式

魏鹏轶 , 乔钢 , 邵玮 , 崔玮佳 , 冯兆峰 , 谷亚彤 , 张瑜 . 中医综合康复在老年转子间骨折术后的应用[J]. 科技导报, 2024 , 42(22) : 76 -83 . DOI: 10.3981/j.issn.1000-7857.2024.06.00631

Abstract

Elderly patients of intertrochanteric fracture suffered in high surgical mortality rate and bad prognosis. This study aims to clarify the clinical value of Chinese medicine comprehensive rehabilitation on postoperative complications, rehabilitation progress, and long-term prognosis of elderly patients with intertrochanteric fractures. Perioperative rehabilitation indicators include the first ambulation without assistance after surgery, drainage volume, visual analogue scale (VAS) score for pain, and bilateral thigh circumference difference. Long-term prognosis and rehabilitation evaluation include Harris score for hip joint function and ADL score. The results showed that the first ambulation time, total postoperative drainage volume, VAS scores of the affected limb and the differences in bilateral thigh circumference both at 1 week after surgery and discharge in the group of Chinese medicine comprehensive rehabilitation were significantly lower than those in the control group. The Harris score and ADL score at 1 month after surgery of the Chinese medicine group were significantly higher than those in the control group. The postoperative ADL score in the Chinese medicine group was significantly higher than that in the control group, and the overall incidence of complications was significantly lower than that in the control group. Comprehensive rehabilitation of Chinese medicine can significantly reduce the hidden blood loss, edema, and pain during the perioperative period after fracture surgery, promote early functional recovery of patients, accelerate postoperative recovery of hip joint function, and improve the overall prognostic quality of life for the patients.

参考文献

[1] 徐畅, 于守业, 马殿栋, 等. 仿生人工髋关节联合改良入路对肌力降低老年患者的康复意义[J]. 科技导报, 2023, 41(23): 56-63.
[2] 李儒雅, 芮云峰. 老年股骨转子间骨折围术期应用氨甲环酸的研究进展[J]. 东南大学学报(医学版), 2021, 40(2): 261-265.
[3] Kanis J A, Odén A, McCloskey E V, et al. A systematic review of hip fracture incidence and probability of fracture worldwide[J]. Osteoporosis International, 2012, 23(9): 2239-2256.
[4] Senohradski K, Markovic-Denic L, Lesic A, et al. Trends in the incidence of hip fractures[J]. Osteoporosis International, 2013, 24(5): 1759-1763.
[5] Wang L H, Yu W, Yin X J, et al. Prevalence of osteoporosis and fracture in China: The China osteoporosis prevalence study[J]. JAMA Network Open, 2021, 4(8): e2121106.
[6] Alzahrani K, Gandhi R, Davis A, et al. In-hospital mortality following hip fracture care in southern Ontario[J]. Canadian Journal of Surgery Journal Canadien de Chirurgie, 2010, 53(5): 294-298.
[7] 方美华, 郑明军, 汪翠娟. 益肾接骨汤在老年股骨转子间骨折PFNA术后的应用效果观察[J]. 中国中医药科技, 2022, 29(4): 594-596.
[8] 余小燕, 刘洋, 谷晓慧, 等. 针刺麻醉与镇痛泵在肩关节术后镇痛领域中的应用及评价[J]. 科技导报, 2023, 41(3): 44-50.
[9] 李冉, 付超, 刘杨, 等. 云南白药保险子在重度创伤性失血急救中的应用[J]. 科技导报, 2022, 40(23): 78-84.
[10] 周玺嫔. 火龙罐循经治疗对老年股骨颈骨折患者半髋术后髋关节功能影响的研究进展[J]. 东方药膳, 2021(22): 298.
[11] 王志彬, 丁杰, 陈根, 等. 基于实时应变弹性成像对上交叉综合征患者肌肉功能的康复评定[J]. 科技导报, 2023, 41(23): 35-41.
[12] Jasty M J, Floyd W E 3rd, Schiller A L, et al. Localized osteolysis in stable, non-septic total hip replacement[J]. The Journal of Bone and Joint Surgery American Volume, 1986, 68(6): 912-919.
[13] 黄志环, 张丽莉, 范玉荣. Barthel指数指导下角色履职活动模式对脑梗死患者肢体功能及生活质量影响分析[J]. 中国医学创新, 2022, 19(10): 109-114.
[14] 蔡毅, 赵继荣, 朱换平, 等. 基于“肾主骨生髓”理论探讨脊髓损伤继发骨质疏松的病机及临床治疗[J]. 中国骨质疏松杂志, 2021, 27(1): 131-134, 152.
[15] 刘素明, 杨礼跃, 王泰俊, 等. 益肾补骨汤促进骨质疏松性股骨转子间骨折患者股骨近端防旋髓内钉术后骨折愈合的效果及作用机制分析[J]. 广州中医药大学学报, 2022, 39(1): 56-62.
[16] 徐小东, 王颜华, 司徒炫明, 等. 综合康复治疗对老年股骨转子间骨折患者术后功能的影响研究[J]. 中华创伤骨科杂志, 2021, 23(6): 543-547.
[17] 费国芳, 费红良, 王金法. 两种内固定方法治疗老年不稳定性股骨转子间骨折的对比研究[J]. 中医正骨, 2016, 28(5): 9-12.
[18] 秦伟光. 老年股骨转子间骨折内固定治疗的研究进展[J]. 系统医学, 2021, 6(10): 195-198.
[19] Chatterton B D, Moores T S, Ahmad S, et al. Cause of death and factors associated with early in-hospital mortality after hip fracture[J]. The Bone & Joint Journal, 2015, 97-B(2): 246-251.
[20] Jordan M, Aguilera X, González J C, et al. Prevention of postoperative bleeding in hip fractures treated with prosthetic replacement: Efficacy and safety of fibrin sealant and tranexamic acid. A randomised controlled clinical trial (TRANEXFER study) [J]. Archives of Orthopaedic and Trauma Surgery, 2019, 139(5): 597-604.
[21] Dillon M F, Collins D, Rice J, et al. Preoperative characteristics identify patients with hip fractures at risk of transfusion[J]. Clinical Orthopaedics and Related Research, 2005, 439: 201-206.
[22] 罗涛, 黄伟杰, 吴伟, 等. 股骨粗隆间骨折围手术期隐性失血初步分析[J]. 实用骨科杂志, 2011, 17(9): 796-799, 862.
[23] Foss N B, Kehlet H. Hidden blood loss after surgery for hip fracture[J]. The Journal of Bone and Joint Surgery British Volume, 2006, 88(8): 1053-1059.
[24] 史庆轩, 胡宏伟, 宁廷民, 等. PFNA治疗高龄股骨粗隆间骨折隐性失血的发生机制及影响因素初步分析[J]. 中国矫形外科杂志, 2014, 22(14): 1262-1265.
[25] 周宗科, 黄泽宇, 杨惠林, 等. 中国骨科手术加速康复围手术期氨甲环酸与抗凝血药应用的专家共识[J]. 中华骨与关节外科杂志, 2019, 12(2): 81-88.
[26] 王晓鹏, 张乃方, 瞿沉尘, 等. 浅议《医碥》对中医内科急诊重症学科的论述和贡献[J]. 中国中医急症, 2018, 27(9): 1658-1660.
[27] 罗时运, 陈树清, 王少云, 等. 循经推拿结合康复锻炼对下肢骨折术后肿胀的影响分析[J]. 中医临床研究, 2019, 11(24): 129-130.
[28] Pasyar N, Rambod M, Kahkhaee F R. The effect of foot massage on pain intensity and anxiety in patients having undergone a tibial shaft fracture surgery: A randomized clinical trial[J]. Journal of Orthopaedic Trauma, 2018, 32(12): e482-e486.
[29] 翟伟韬, 戴号, 王凌椿. 中医手法在僵硬膝人工全膝关节置换术术后关节活动度恢复中的应用[J]. 河北中医, 2012, 34(12): 1835-1837.
[30] 李坤, 刘云鹏. 股骨髓腔内应用氨甲环酸对老年股骨粗隆间骨折患者PFNA围手术期出血及纤溶功能、炎症反应的影响[J]. 创伤外科杂志, 2020, 22(12): 923-927.
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