Application of a staged functional training program based on IPC model in postoperative patients with unstable distal radius fractures
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摘要:
目的 基于跨专业合作模式(IPC)构建不稳定桡骨远端骨折术后阶段性功能训练方案，探讨其对患者预后的影响。 方法 选取2023年10月—2024年9月在绍兴市上虞人民医院骨科住院手术治疗的100例不稳定桡骨远端骨折患者为研究对象。采用随机数字表法将患者分为2组，每组各50例，对照组术后实施常规护理，观察组术后实施阶段性功能训练。观察比较2组训练前后疼痛、腕关节功能以及上肢功能情况。 结果 观察组术后疼痛程度低于对照组，住院时间及患肢消肿时间均短于对照组(P＜0.05)；2组12周后功能状况、活动范围、握力、疼痛评分均高于干预前(P＜0.05)，且观察组功能状况、活动范围、握力、疼痛评分均高于对照组(P＜0.05)；12周后2组上肢运动功能简式评分表(DASH)评分均低于干预前，且观察组DASH评分低于对照组(P＜0.05)；观察组术后关节僵硬1例，固定松动1例，骨折愈合延迟1例，并发症总发生率为6.00%(3/50)，显著低于对照组的24.00%(12/50，χ2=6.353，P=0.012)。 结论 在不稳定桡骨远端骨折术后功能训练中采用基于IPC模式的阶段性功能训练方案能减轻骨折患者早期疼痛，促进患肢消肿，缩短住院时间，且有利于腕关节及上肢功能恢复，降低术后并发症发生风险。 Abstract:Objective To evaluate the effectiveness of a staged functional training program based on the interprofessional cooperation model (IPC) in patients with unstable distal radius fractures. Methods A total of 100 patients with unstable distal radius fractures admitted to the Orthopedic Department of Shangyu People ' s Hospital of Shaoxing from October 2023 to September 2024 were selected and divided into two groups by the random number table method, with 50 cases in each group. The control group received routine postoperative care, while the observation group underwent a staged functional training program after surgery. The pain intensity, wrist joint function, and upper limb function were compared between the two groups before and after the intervention. Results The postoperative pain intensity in the observation group was lower than that in the control group. The length of hospitalization duration and time to resolution of swelling in the affected limb were also shorter than those in the control group (P < 0.05). At 12 weeks post-intervention, both groups demonstrated significant improvements in functional status, range of motion, grip strength, and pain scores compared to baseline (P < 0.05). Furthermore, the observation group exhibited significantly better outcomes in functional status, range of motion, grip strength, and pain scores compared to the control group (P < 0.05). Additionally, both groups showed reduced disabilities of the arm, shoulder and hand (DASH) scores at 12 weeks compared to pre-intervention levels (P < 0.05), with the observation group achieving significantly lower scores than the control group (P < 0.05). In terms of complications, the observation group experienced 1 case each of postoperative joint stiffness, fixation loosening, and delayed fracture healing, resulting in a total complication rate of 6.00% (3/50), which was significantly lower than the 24.00% (12/50) observed in the control group (χ2=6.353, P=0.012). Conclusion The application of a staged functional training program based on the IPC model in the postoperative rehabilitation for patient with unstable distal radius fractures can alleviate early postoperative pain, promote swelling reduction in the affected limb, shorten hospital stay, facilitate wrist and upper functional recovery, and reduce the risk of postoperative complications. -
表 1 2组不稳定桡骨远端骨折患者基线资料比较
Table 1. Comparison of baseline data between two groups of patients with unstable distal radius fractures
组别 例数 年龄(x ± s，岁) 性别(例) 损伤原因(例) 伤后就诊时间(x ± s，h) AO/ASIF分型(例) 男性 女性 交通意外 跌伤 坠落伤 C1 C2 C3 对照组 50 52.68±5.97 33 17 17 19 14 15.30±6.23 15 21 14 观察组 50 53.84±6.18 37 13 21 20 9 16.24±6.16 17 19 14 统计量 0.955a 0.762b 1.534b 0.759a 0.225b P值 0.342 0.382 0.465 0.450 0.894 注：AO/ASIF为国际内固定研究协会骨折分型。a为t值, b为χ2值。 
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表 2 阶段性功能训练方案
Table 2. Staged functional training protocol
阶段 具体项目 1.初期阶段(术后0~6周) 1.1固定当天 手指主动弯曲和伸展手指主动运动，15 min/次，2次/d。 1.2术后第1~2周 (1)肩关节摆动练习，10 min/次，2次/d。 (2)肘关节屈伸练习，10 min/次，2次/d。 1.3术后第3~6周 (1)握拳训练：摊开手掌，蜷曲四指形成平整拳面，大拇指搭在食指和中指的关节上，调整手腕角度，确保击打时拳面接触物体时手腕不会弯折。5 min/次，2次/d。 (2)屈腕肌训练：握住重物，如杠铃、哑铃等，掌心向上。将前臂放在平面上，手腕悬空。呼气，手腕向上屈，重物靠近前臂，感受前臂屈肌群收缩。动作最高点停顿，进行顶峰收缩。吸气，缓慢还原手腕至起始位置，保持前臂稳定。控制动作速度，避免过快或过慢。5 min/次，2次/d。 (3)伸腕肌的静力性收缩：将上臂稳定放在桌面或大腿上，手腕自然下垂，确保训练时上臂不动。手持哑铃，准备做伸腕动作，手指朝上，手掌平稳。用腕力缓慢举起哑铃，注意上臂不得离开桌面或大腿。哑铃举至最高点时，保持3 s后缓慢控制地放下哑铃，回到起始位置，放下过程中保持上臂不动。5 min/次，2次/d。 2.中期阶段(术后6~8周) 2.1术后第6周 握力器抗阻训练：手握握力器，保持手腕稳定，用力将握力器闭合，直至感到肌肉紧绷，然后，缓慢地放松手指，让握力器恢复到初始状态。在此过程中，注意保持动作的平稳和受控，避免使用爆发力。20 min/次，1次/d。 2.2术后第7~8周 弹力带抗阻训练：将弹力带缠绕在手掌上，根据个人力量水平调整弹力带的张力。先用力将手腕向前弯曲，使弹力带产生张力，感受前臂肌肉的收缩；再缓慢地将手腕向后伸展，使弹力带恢复到初始状态。20 min/次，1次/d。 3.后期阶段(术后8~12周) 3.1术后第8~10周 (1)强化训练：继续进行抓握、挤捏、对指等精细动作练习，以及前臂旋前旋后体位下的腕掌屈、腕背伸等练习，以进一步恢复关节活动度和肌肉力量。30 min/次，2次/d。 3.2术后第11~12周 (2)功能性训练：鼓励患者进行日常生活活动训练，如穿衣、洗漱、进食等，以提高患肢功能。3次/d。
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表 3 2组不稳定桡骨远端骨折患者临床指标比较(x ± s)
Table 3. Comparison of clinical indicators between two groups of patients with unstable distal radius fractures (x ± s)
组别 例数 术后1周VAS评分(分) 住院时间(d) 患肢消肿时间(d) 对照组 50 6.40±2.97 10.29±2.34 15.36±3.59 观察组 50 3.92±0.93 8.58±2.78 12.62±3.47 t值 5.635 3.328 3.880 P值 ＜0.001 0.001 ＜0.001
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表 4 2组不稳定桡骨远端骨折患者干预前、12周后腕关节功能评分比较(x ± s，分)
Table 4. Comparison of pre-intervention and 12-week post-intervention wrist joint function scores between two groups of patients with unstable distal radius fractures (x ± s, points)
组别 例数 功能状况 活动范围 握力 疼痛 干预前 12周后 干预前 12周后 干预前 12周后 干预前 12周后 对照组 50 15.32±3.20 17.24±3.14b 12.68±4.61 14.96±4.77b 14.10±4.45 16.64±4.92b 15.10±3.48 16.98±3.54b 观察组 50 15.16±3.15 19.30±2.94b 12.79±4.45 17.48±4.32b 14.26±5.11 19.00±3.76b 15.24±3.55 18.58±3.31b 统计量 0.252a 10.369c 0.121a 11.248c 0.167a 11.387c 0.199a 12.044c P值 0.802 ＜0.001 0.904 ＜0.001 0.868 ＜0.001 0.843 ＜0.001 注：a为t值，c为F值；与同组干预前比较，bP＜0.05。
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表 5 2组不稳定桡骨远端骨折患者DASH评分比较(x ± s，分)
Table 5. Comparison of DASH scores between two groups of patients with unstable distal radius fractures (x ± s, points)
组别 例数 DASH评分 干预前 12周后 对照组 50 62.52±12.59 46.16±11.55b 观察组 50 63.00±11.59 38.20±11.13b 统计量 0.198a 12.648c P值 0.843 ＜0.001 注：a为t值，c为F值；与同组干预前比较，bP＜0.05。
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表 6 2组不稳定桡骨远端骨折患者术后并发症发生情况比较[例(%)]
Table 6. Comparison of postoperative complications between two groups of patients with unstable distal radius fractures [cases (%)]
组别 例数 关节僵硬 再位移 固定松动 骨折延迟愈合 总发生 对照组 50 3(6.00) 1(2.00) 2(4.00) 6(12.00) 12(24.00) 观察组 50 1(2.00) 0 1(2.00) 1(2.00) 3(6.00) 注：2组术后并发症总发生率比较，χ2=6.353，P=0.012。
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[1] YEN H K, CHANG Y L, HUANG W L, et al. Letter to the editor: How does the addition of dexamethasone to a brachial plexus block change pain patterns after surgery for distal radius fractures? A randomized, double-blind study[J]. Clin Orthop Relat Res, 2024, 482(3): 566-567. doi: 10.1097/CORR.0000000000002964 [2] 张积森, 方家刘, 谢武昆, 等. 组合式撑开器在难复性桡骨远端骨折治疗中的应用[J]. 中华骨科杂志, 2022, 42(5): 281-289.ZHANG J S, FANG J L, XIE W K, et al. Application of combined distractor in the treatment of refractory distal radius fractures[J]. Chinese Journal of Orthopaedics, 2022, 42(5): 281-289. [3] SAODEKAR H, SALPHALE Y S, SHINDE G, et al. Novel surgical method for the exposure and plating of dorsally displaced unstable distal radius fractures[J]. Trauma Case Rep, 2024, 54: 101111. DOI: 10.1016/j.tcr.2024.101111. [4] ŻYLUK A. Assessment of pain severity and grip strength as the most accurate predictors of the outcome of treatment of distal radial fractures[J]. Ortop Traumatol Rehabil, 2024, 26(2): 1-10. doi: 10.5604/01.3001.0054.6544 [5] 中华医学会骨科学分会创伤骨科学组, 中华医学会骨科学分会外固定与肢体重建学组. 中国成人桡骨远端骨折诊疗指南(2023)[J]. 中华创伤骨科杂志, 2023, 25(1): 6-13.Trauma Orthopaedic Group, Orthopaedic Branch, Chinese Medical Association, External Fixation and Limb Reconstruction Group, Orthopaedic Branch, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of adult distal radius fracture (2023)[J]. Chinese Journal of Orthopaedic Trauma, 2023, 25(1): 6-13. [6] 倪博然, 赵进喜, 黄为钧, 等. 基于视觉模拟评分法探究中医临床疗效评价新方法[J]. 中华中医药杂志, 2021, 36(1): 288-292.NI B R, ZHAO J X, HUANG W J, et al. A new method to evaluate the clinical efficacy of traditional Chinese medicine based on visual analog scoring[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2021, 36(1): 288-292. [7] 许伟新. 英文版腕关节功能患者自评量表的汉化及其信度研究[J]. 中华物理医学与康复杂志, 2003, 25(8): 465-467.XU W X. The chinese version of the patient rated wrist evaluation (PRWE): cross-culture adaptation and reliability test[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2003, 25(8): 465-467. [8] 刘阳, 李建华. 中文版上肢功能障碍问卷对脑卒中上肢功能评价的信度研究[J]. 浙江医学, 2019, 41(13): 1399-1401, 1405.LIU Y, LI J H. Reliability of DASH questionnaire Chinese version for stroke patients[J]. Zhejiang Medical Journal, 2019, 41(13): 1399-1401, 1405. [9] 何文浩, 纪亲龙. 切开复位桡骨远端掌侧钢板内固定术治疗不稳定型桡骨远端骨折临床观察[J]. 贵州医药, 2022, 46(6): 875-876.HE W H, JI Q L. Clinical observation of open reduction and volar plate internal fixation for unstable distal radius fractures[J]. Guizhou Medical Journal, 2022, 46(6): 875-876. [10] 金文, 孙良业, 凤晓翔, 等. 尺骨茎突Ⅱ型骨折对桡骨远端骨折术后腕关节功能的影响[J]. 西部医学, 2023, 35(8): 1183-1187.JIN W, SUN L Y, FENG X X, et al. Effect of ulnar styloid type Ⅱ fracture on wrist function after distal radius fracture[J]. Medical Journal of Western China, 2023, 35(8): 1183-1187. [11] 李阳, 谢康, 袁毅, 等. 造影下克氏针撬拨复位弹性髓内钉固定治疗低龄儿童Judet Ⅳ型桡骨颈骨折效果观察[J]. 中华全科医学, 2021, 19(9): 1459-1462. doi: 10.16766/j.cnki.issn.1674-4152.002085LI Y, XIE K, YUAN Y, et al. Treatment of Judet Ⅳ type radial neck fracture in young children with Kirschner wire percutaneous leverage reduction and elastic intramedullary nail fixation under elbow arthrography[J]. Chinese Journal of General Practice, 2021, 19(9): 1459-1462. doi: 10.16766/j.cnki.issn.1674-4152.002085 [12] 鞠英实, 孙波. 护理干预在外固定支架固定术治疗下尺桡关节脱位中的应用[J]. 北华大学学报(自然科学版), 2023, 24(6): 800-804.JU Y S, SUN B. Nursing intervention in treatment of lower ulnar radial dislocation with external fixation stent fixation[J]. Journal of Beihua University (Natural Science Edition), 2023, 24(6): 800-804. [13] PATHAN A, UTTAMCHANDANI S R, JAGZAPE M V, et al. Volar barton fracture and ulnar styloid fracture with distal radial ulnar joint disruption of the right wrist without neurovascular deficit[J]. Cureus, 2023, 15(10): 47864. DOI: 10.7759/cureus.47864. [14] 陈波涛, 潘莎, 杨利. 带沟槽夹板固定老年桡骨远端骨折对患肢早期肿胀和血流速度的影响[J]. 中国骨伤, 2024, 37(10): 953-958.CHEN B T, PAN S, YANG L. Effect of groove splint fixation on early swelling and blood flow velocity of the injury limb in elderly patients with dis-tal radius fractures[J]. China Journal of Orthopaedics and Traumatology, 2024, 37(10): 953-958. [15] ZHANG J Y, SAMINENI A V, SING D C, et al. Higher-than-expected rates of distal radioulnar joint fixation in radial shaft fractures: location of fracture matters[J]. Hand (N Y), 2023, 18(2): 328-334. doi: 10.1177/15589447211006836 [16] ZHANG J, BRADSHAW F, DUCHNIEWICZ M, et al. Epidemiology and incidence of upper limb fractures: a UK level 1 trauma center perspective[J]. Cureus, 2024, 16(2): 54961. DOI: 10.7759/cureus.54961. [17] YOǦUN Y, BEZIRGAN U, ERTAN M B, et al. The relationship between soong classification and fracture characteristics with implant removal for distal radius fractures: a comparative study of 795 cases[J]. Orthop Traumatol Surg Res, 2025, 17: 104172. DOI: 10.1016/j.otsr.2025.104172. [18] 李静, 徐一杰, 江丽. 早期功能锻炼治疗桡骨远端骨折手法复位后动态小夹板固定患者的临床疗效[J]. 中国中西医结合外科杂志, 2024, 30(3): 338-342.LI J, XU Y J, JIANG L. Effect of early functional exercise on patients with distal radius fractures undergoing dynamic small splint fixation after manual reduction[J]. Chinese Journal of Integrated Traditional and Western Surgery, 2024, 30(3): 338-342. -
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