“筋骨并重”康复理论在Pilon患者术后应用及对深静脉血栓的预防效果

杨涛; 王文辉; 姜涛

doi:10.16766/j.cnki.issn.1674-4152.002340

“筋骨并重”康复理论在Pilon患者术后应用及对深静脉血栓的预防效果

doi: 10.16766/j.cnki.issn.1674-4152.002340

大连市第二人民医院创伤骨科，辽宁大连 116001

基金项目:

辽宁省科学技术计划项目 2019-ZD-0965

详细信息

通讯作者:
杨涛, E-mail: 174879038@qq.com

中图分类号: R683.42 R493
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- 被引次数: 0
出版历程
- 收稿日期: 2021-04-21
- 网络出版日期: 2022-03-04

Application of rehabilitation theory of "paying equal attention to sinew and bone" in postoperative Pilon patients and its preventive effect on deep vein thrombosis

Orthopaedic Trauma Department, Dalian Second People's Hospital, Dalian, Liaoning 116001, China

摘要

摘要: 目的探讨“筋骨并重”康复理论在胫骨远端爆裂性骨折(Pilon骨折)患者术后应用及对深静脉血栓(DVT)的预防效果。方法选择2017年6月—2019年12月大连市第二人民医院收治的胫骨Pilon骨折行切开复位内固定术患者86例，采用随机数字表法分为对照组(常规康复训练，43例)和观察组(“筋骨并重”康复理论，43例)，收集对比患者一般资料；记录2组患者术后1 d、2周、4周后踝关节肿胀程度、踝关节功能、关节活动度评分；记录患者水肿消退时间、骨性愈合时间及并发症情况。结果 2组一般资料比较差异无统计学意义(均P＞0.05)。术后2周和4周观察组踝关节肿胀程度低于对照组(均P＜0.05)，观察组踝关节功能明显好于对照组(P＜0.05)，观察组关节活动度明显好于对照组(P＜0.05)。对照组水肿消退时间、骨性愈合时间明显长于观察组。对照组局部感染6例(13.95%)，DVT 4例(9.30%)，观察组局部感染1例(2.33%)，DVT 2例(4.65%)，对照组并发症发生率显著高于观察组(P＜0.05)。2组患者康复预期值构成比差异无统计学意义(P＞0.05)，满意度观察组高于对照组，差异有统计学意义(P＜0.05)。结论 “筋骨并重”康复理论指导下进行康复训练能够有效预防Pilon患者术后DVT的形成，值得临床应用，推广价值较高。
- 深静脉血栓 /
- “筋骨并重”康复理论 /
- 胫骨远端爆裂性骨折 /
- 切开复位内固定术
Abstract: Objective To explore the application of rehabilitation theory of "paying equal attention to sinew and bone" in postoperative patients with distal tibial burst fracture (Pilon fracture) and its preventive effect on deep venous thrombosis (DVT). Methods A total of 86 cases of tibial Pilon fracture treated in Dalian Second People's Hospital from June 2017 to December 2019 were selected for open reduction and internal fixation. They were randomly divided into control group (routine rehabilitation training) with 42 cases and observation group (rehabilitation theory of paying equal attention to sinew and bone) with 43 cases. The general data of the patients were collected and compared. The swelling degree of ankle joint, ankle joint function, and joint activity scores of the two groups were recorded one day, two weeks, and four weeks after operation. The edema-regression time, bone healing time, and complications were recorded. Results No significant difference was observed between the control and observation groups (all P > 0.05). Two and four weeks after operation, the degree of ankle swelling, ankle joint function, and joint activity in the observation group were better than those in the control group (all P < 0.05). Edema-regression time and bone-healing time in the control group were significantly longer than those in the observation group. In the control group, 6 cases were local infection (14.28%), 4 cases were DVT (9.52%), 1 case was local infection (2.32%), and 2 cases were DVT (4.65%). The incidence of complication in the control group was significantly higher than that in the observation group (P < 0.05). No significant difference was observed in the expected values of rehabilitation between the two groups (P > 0.05), but the satisfaction of the observation group was higher than that of the control group (P < 0.05). Conclusion Rehabilitation training guided by the rehabilitation theory of "paying equal attention to sinew and bone" can effectively prevent postoperative DVT formation in Pilon patients and is thus worthy of clinical application and promotion.

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表 1 2组Pilon骨折患者基线资料比较

组别	例数	性别(例)		年龄(x±s，岁)	手术时间(x±s，min)	骨折分型(例)
组别	例数	男性	女性	年龄(x±s，岁)	手术时间(x±s，min)	Ⅰ型	Ⅱ型	Ⅲ型
对照组	43	24	19	38.46±5.03	97.45±2.71	10	21	12
观察组	43	22	21	39.54±5.10	97.37±2.62	11	20	12
统计量		0.187^a		0.989^b	0.104^b	0.050^c
P值		0.665		0.326	0.917	0.823
注：^a为χ²值，^b为t值，^c为H值。

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表 2 2组Pilon骨折患者不同时间踝关节肿胀程度比较(x±s，cm)

组别	例数	术后1 d	术后2周	术后4周	F值	P值
对照组	43	3.24±0.49	2.08±0.42^a	1.09±0.27^ab	302.581	＜0.001
观察组	43	3.19±0.47	1.86±0.43^a	0.66±0.49^ab	318.474	＜0.001
t值		0.483	2.400	5.040
P值		0.630	0.019	＜0.001
注：与术后1 d比较，^aP＜0.05；与术后2周比较，^bP＜0.05。

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表 3 2组Pilon骨折患者不同时间踝关节功能评分比较(x±s，分)

组别	例数	术后1 d	术后2周	术后4周	F值	P值
对照组	43	7.42±0.94	10.10±1.12^a	16.81±1.91^ab	558.241	＜0.001
观察组	43	7.47±0.83	14.44±1.96^a	25.37±2.34^ab	1011.098	＜0.001
t值		0.061	133.545	306.744
P值		0.806	＜0.001	＜0.001
注：与术后1 d比较，^aP＜0.05；与术后2周比较，^bP＜0.05。

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表 4 2组Pilon骨折患者不同时间关节活动度评分比较(x±s，分)

组别	例数	术后1 d	术后2周	术后4周	F值	P值
对照组	43	6.15±0.40	9.08±0.82^a	10.05±1.36^ab	196.921	＜0.001
观察组	43	6.04±0.41	13.21±0.80^a	15.83±1.46^ab	1 279.644	＜0.001
t值		1.262	444.541	357.882
P值		0.268	＜0.001	＜0.001
注：与术后1 d比较，^aP＜0.05；与术后2周比较，^bP＜0.05。

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表 5 2组Pilon骨折患者术后恢复情况及并发症发生情况比较

组别	例数	水肿消退时间(x±s，d)	骨性愈合时间(x±s，d)	并发症[例(%)]
对照组	43	9.21±1.95	139.62±4.26	10(23.26)
观察组	43	6.47±1.63	115.71±6.24	3(6.98)
统计量		7.070^a	29.295^a	4.440^b
P值		＜0.001	＜0.001	0.035
注：^a为t值，^b为χ²值。

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表 6 2组Pilon患者康复预期值和满意度情况

组别	例数	康复预期值(例)			满意度[例(%)]
组别	例数	高	中	低	满意度[例(%)]
对照组	43	24	13	6	35(81.39)
观察组	43	23	15	5	41(95.35)
统计量		0.679^a			4.468^b
P值		0.452			0.035
注：^a为H值，^b为χ²值。

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