FMEA理论协同护理在股骨粗隆间骨折中的应用价值

周敏捷; 凌乐洁; 李玉洁; 骆国钢

doi:10.16766/j.cnki.issn.1674-4152.004026

FMEA理论协同护理在股骨粗隆间骨折中的应用价值

doi: 10.16766/j.cnki.issn.1674-4152.004026

温州市中西医结合医院创伤骨科，浙江温州 325000

基金项目:

浙江省中医药科技计划项目 2021ZB275

温州市基础性公益科研项目 Y2023482

详细信息

通讯作者:
凌乐洁，E-mail：307085247@qq.com

中图分类号: R683.42 R473.6
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- 文章访问数: 6
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- 被引次数: 0
出版历程
- 收稿日期: 2024-06-19
- 网络出版日期: 2025-08-14

Application value of FMEA theory in collaborative nursing in femoral trochanteric fracture

Department of Traumatology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的股骨粗隆间骨折是临床常见病症之一，其发生率和罹患率不断上升，早期予以手术治疗是主要手段，而术后科学的管理方法是促进骨折功能恢复及降低并发症风险的关键措施，为进一步优化股骨粗隆间骨折围手术期管理措施，本研究探讨基于失效模式与效应分析(FMEA)理论的协同护理对股骨粗隆间骨折功能恢复及并发症的影响。方法选取温州市中西医结合医院2022年1月—2023年6月收治的80例股骨粗隆间骨折患者，按照随机数字表法分为对照组和观察组，均40例。将予以常规康复护理干预的患者作为对照组，在对照组基础上予以基于FMEA理论的协同护理为观察组。比较2组康复锻炼依从性，采用Harris评分系统(HHS)评价髋关节功能及并发症(压疮、感染、下肢静脉血栓)情况。结果观察组干预后康复锻炼依从性高于对照组(P＜0.05)；观察组干预后HHS评分系统中的疼痛、功能、关节活动度、畸形各维度评分均高于对照组(P＜0.05)；观察组并发症发生率为2.50%(1/40)，显著低于对照组的20.00%(8/40，χ²=4.507，P=0.034)。结论 FMEA理论协同护理的实施可促使股骨粗隆间骨折患者关节功能快速恢复，提高康复锻炼依从性，减少并发症发生。
- 股骨粗隆间骨折 /
- 失效模式与效应分析 /
- 协同护理 /
- 关节功能
Abstract: Objective Trochanteric fracture of femur is one of the common clinical diseases with an increasing incidence and incidence rate. Early surgical treatment is the main means, and scientific postoperative management is the key measure to promote functional recovery of fracture and reduce the risk of complications. In order to further optimize perioperative management measures of trochanteric fracture of femur, This study investigated the effects of collaborative nursing based on failure modes and effects analysis (FMEA) theory on functional recovery and complications of femoral trochanteric fracture. Methods A total of 80 patients with femoral trochanteric fracture admitted to Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to June 2023 were selected and divided into 2 groups according to the random number table method, with 40 cases in both control group and observation group. Patients who received routine rehabilitation nursing interventions served as the control group, and the observation group received routine rehabilitation nursing interventions and collaborative nursing based on FMEA theory on top of the control group. The compliance of rehabilitation exercise between the two groups was compared, and hip function and complications (pressure sores, infection, venous thrombosis of lower limbs) were evaluated by the Harris score system (HHS). Results The compliance of rehabilitation exercise in the observation group was higher than that in the control group (P < 0.05). After intervention, the scores of pain, function, joint motion, and deformity in the observation group were higher than those in the control group (P < 0.05). The complication rate of the observation group was 2.50% (1/40), which was significantly lower than that of the control group [20.00% (8/40), χ²=4.507, P=0.034]. Conclusion The implementation of FMEA theory can promote the rapid recovery of joint function in patients with femoral trochanteric fracture, improve the compliance of rehabilitation exercise, and reduce the occurrence of complications.
- Intertrochanteric fracture of femur /
- Failure mode and effect analysis /
- Collaborative nursing /
- Joint function

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表 1 2组股骨粗隆间骨折患者基线资料比较

Table 1. Comparison of baseline data of patients with intertrochanteric fractures between the two groups

项目	观察组(n=40)	对照组(n=40)	统计量	P值
性别(男性/女性，例)	24/16	26/14	0.213^a	0.644
年龄(x±s，岁)	68.26±6.35	69.01±5.87	0.549^b	0.585
吸烟史[例(%)]	22(55.00)	20(50.00)	0.201^a	0.654
BMI(x±s)	23.15±1.68	22.98±1.84	0.432^b	0.667
受教育年限(x±s，年)	10.25±2.87	10.16±3.02	0.137^b	0.892
骨折部位[例(%)]			0.201^a	0.654
左侧	22(55.00)	20(50.00)
右侧	18(45.00)	20(50.00)
受伤原因[例(%)]			1.442^a	0.486
跌倒	21(52.50)	22(55.00)
交通伤	14(35.00)	16(40.00)
砸伤	5(12.50)	2(5.00)
骨折分型[例(%)]			0.205^a	0.651
Ⅲ型	22(55.00)	24(60.00)
Ⅳ型	18(45.00)	16(40.00)
注：^a为χ²值，^b为t值。

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表 2 2组股骨粗隆间骨折患者干预前后康复锻炼依从性比较(x±s，分)

Table 2. Comparison of rehabilitation exercise compliance between the two groups of patients with intertrochanteric fracture before and after intervention(x±s, points)

组别	例数	干预前	干预1个月	干预3个月
观察组	40	18.26±3.65	28.85±4.98^a	34.29±5.32^a
对照组	40	18.09±3.47	25.96±5.02^a	31.57±4.85^a
F值		1.106	22.016	20.203
P值		0.754	＜0.001	＜0.001
注：与同组干预前比较，^aP＜0.05。F_时间=3.190，P_时间=0.031；F_组间=209.70，P_组间＜0.001；F_交互=10.510，P_交互=0.001。

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表 3 2组股骨粗隆间骨折患者干预前后髋关节功能比较(x±s，分)

Table 3. Comparison of hip function between the two groups of patients with intertrochanteric fracture before and after intervention(x±s, points)

组别	例数	疼痛			功能
组别	例数	干预前	干预1个月	干预3个月	干预前	干预1个月	干预3个月
观察组	40	20.26±4.25	30.26±3.26^a	36.46±5.69^a	21.23±3.26	29.94±4.65^a	37.64±6.02^a
对照组	40	20.98±5.02	27.37±3.81^a	33.98±4.62^a	22.02±3.42	27.29±5.03^a	34.87±5.91^a
F值		1.395	11.365	12.280	1.101	12.170	12.038
P值		0.033	＜0.001	＜0.001	0.766	＜0.001	＜0.001

组别	例数	关节活动度			畸形
组别	例数	干预前	干预1个月	干预3个月	干预前	干预1个月	干预3个月
观察组	40	2.01±0.18	2.54±0.52^a	3.16±0.31^a	2.08±0.33	2.44±0.34^a	3.11±0.27^a
对照组	40	2.02±0.22	2.26±0.42^a	2.91±0.34^a	2.01±0.38	2.19±0.39^a	2.89±0.44^a
F值		1.494	12.533	12.203	11.326	12.316	12.656
P值		0.215	＜0.001	＜0.001	0.382	＜0.001	＜0.001
注：与同组干预前比较，^aP＜0.05。疼痛，F_时间=3.839，F_组间=210.501，F_交互=7.082；P_时间=0.023，P_组间＜0.001，P_交互=0.008。功能，F_时间=3.490，F_组间=183.00，F_交互=6.107；P_时间=0.032，P_组间＜0.001，P_交互=0.014。关节活动度，F_时间=4.128，F_组间=172.302，F_交互=14.630；P_时间=0.017，P_组间＜0.001，P_交互=0.001。畸形，F_时间=3.417，F_组间=147.70，F_交互=14.810；P_时间=0.034，P_组间＜0.001，P_交互=0.001。

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表 4 2组股骨粗隆间骨折患者并发症比较[例(%)]

Table 4. Comparison of complications in patients with intertrochanteric fracture of femur between the two groups[cases(%)]

组别	例数	感染	压疮	深静脉血栓	总发生
观察组	40	0	0	1(2.50)	1(2.50)
对照组	40	3(7.50)	1(2.50)	4(10.00)	8(20.00)
注：2组并发症总发生率比较，χ²=4.507，P=0.034。

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