老年髋部骨折术后患者康复需求程度与康复状况调查

目的 了解老年髋部骨折术后患者康复需求程度、需求满足度与康复状况的关系。方法 上门随访82例老年髋部骨折术后患者家庭康复现状和康复需求情况。结果 康复需求10个维度中他人支持、康复信息及功能训练指导位居前3位；需求程度与生理功能、躯体功能和社会功能有关（P〈0．05，P〈0．01）；与髋关节功能评分中的疼痛程度、上楼梯、穿鞋袜和行走距离4个方面有关（P〈0．05，P〈0．01）。结论 出院后定期给予针对性的康复训练指导和健康教育是患者迫切的需求；康复需求程度高者，相应需求满足率低，其生活质量及髋关节功能恢复应成为干预的重点。     

引导式教育在老年髋部骨折患者术后康复护理中的应用

目的探讨引导式教育对老年髋部骨折患者术后不同时段康复锻炼依从性和髋关节功能康复的影响。方法将纳入标准的129例老年髋部骨折术后患者作为研究对象,按病区床号分为干预组(64例)和对照组(65例)。两组均给予常规护理,干预组在此基础上结合引导式教育。分别在干预前、出院当天、出院1个月、出院3个月时,对两组患者康复锻炼依从性和髋关节功能康复情况进行比较。结果出院3个月后,干预组康复锻炼依从性、髋关节评分显著高于对照组(均P0.05)。结论引导式教育能有效提高老年髋部骨折患者康复锻炼依从性,改善髋关节功能。     

照顾者思维导图干预对老年髋部骨折患者术后功能康复的影响

目的探讨照顾者思维导图干预对老年髋部骨折患者术后功能康复的影响。方法将108例老年髋部骨折术后患者按照随机数字表法分为对照组和干预组各54例。对照组采取常规健康教育,干预组通过微信平台对照顾者进行思维导图式健康教育,比较两组患者术后Harris评分、Barthel指数得分及照顾者的相关知识和满意度。结果干预3个月后,干预组患者Harris评分、Barthel指数得分及照顾者相关知识知晓和满意度高于对照组,差异有统计学意义(均P0.01)。结论应用思维导图指导老年髋部骨折术后康复锻炼,可提高照顾者对相关知识的掌握程度与满意度,进而改善患者术后髋关节功能和日常生活能力。     

老年髋部骨折患者快速康复方案的临床实施

目的评价老年髋部骨折患者快速康复方案的实施效果。方法将110例老年髋部骨折患者按照随机数字表法分为观察组和对照组各55例。对照组按照老年髋部骨折护理规范实施护理,观察组在常规护理基础上,实施快速康复方案。结果观察组术前等待时间、住院时间显著短于对照组,患者满意度显著高于对照组,且出院后6个月髋关节评分显著高于对照组(P0.05,P0.01)。结论对老年髋部骨折患者实施快速康复方案,能够减少术前等待时间和平均住院日,提高患者满意度,有利于患者髋关节功能恢复,是一种有效的的实践模式。     

格林模式联合微信平台对老年髋部骨折患者康复的影响

目的探讨格林模式联合微信平台对老年髋部骨折患者康复的影响。方法将186例老年髋部骨折患者按入院时间先后分为对照组与观察组各93例。对照组实施常规康复护理,观察组在此基础上采用格林模式联合微信平台的连续康复护理,比较干预前后患者康复知信行、日常生活自理能力及髋关节Harris评分。结果干预后观察组康复知信行各维度得分、日常生活自理能力及髋关节Harris评分显著高于对照组(P0.05,P0.01)。结论实施格林模式联合微信平台的多学科协作康复护理模式能够有效提升老年髋部骨折患者康复知识,改变其康复态度与行为,提高其日常生活自理能力及髋关节功能。     

渐进式功能锻炼对老年髋部骨折患者术后肢体功能恢复的影响

目的 探讨渐进式功能锻炼对老年髋部骨折患者术后肢体功能恢复的效果.方法 将68例老年髋部骨折患者按入住病房分为干预组和对照组各34例.干预组于术后第1天至出院后3个月给予渐进式功能锻炼方案,对照组接受常规护理和门诊随访.比较两组骨折前、出院时、出院后1个月、出院后3个月的Harris评分.结果 干预后,干预组Harris髋关节总评分和疼痛维度、功能维度及关节活动度维度评分显著高于对照组(P<0.05,P<0.01);全髋置换术患者术后髋关节功能预后水平高于内固定手术患者(P<0.01);不同组别和不同手术方式之间在髋关节总评分和各维度评分方面无交互作用(P>0.05).结论 渐进式功能锻炼可有效促进老年髋部骨折患者术后髋关节功能恢复.     

改良多功能康复椅在髋部骨折术后患者中的应用

目的探讨改良多功能康复椅在髋部骨折术后患者康复中的应用效果。方法将60例髋部术后患者随机分成对照组和观察组各30例,对照组采用常规的术后护理及康复功能锻炼,观察组在此基础上采用改良多功能康复椅进行康复训练,采用Harris髋关节评分法评价其效果。结果 6个月后,两组髋关节功能评分比较,差异有统计学意义(P0.01)。结论改良多功能康复椅能促进髋部术后患者功能康复,且安全实用。     

家庭访视指导对髋关节置换术后老年患者院外康复的作用

目的 探讨家庭访视对人工髋关节置换术后老年患者院外康复的影响.方法 将46例行髋关节置换的老年患者随机分为观察组和对照组各23例.时照组住院期间接受常规护理,观察组在此基础上增加3个月的家庭访视指导(每2周访视1次).结果 两组术后3个月Harris髋关节评分、康复知识掌握情况比较,差异有统计学意义(均P＜0.01).结论 家庭访视指导可促进患者肢体功能恢复,提高其生活质量.     

老年髋部骨折患者行人工全髋关节置换术的围手术期血液管理

目的探讨快速康复理念下围手术期血液管理对于老年髋部骨折患者行人工全髋关节置换(THA)术后康复的重要性。方法回顾性分析自2017-01—2017-12行单侧THA的54例老年髋部骨折,28例围手术期在快速康复理念下进行血液管理(观察组),26例围手术期坚持快速康复理念指导但未进行特殊的血液管理(对照组)。比较2组总失血量、总住院时间,术前、术后1 d、术后1周血红蛋白值,以及术后1周、1个月髋关节功能Harris评分。结果 54例均获得随访,随访时间平均5.6(1～12)个月。与对照组相比,观察组术前、术后1 d、术后1周的Hb值及术后1周、术后1个月的髋关节功能Harris评分更高,总失血量、总住院时间更少,差异均有统计学意义(P 0.05)。结论快速康复理念下的血液管理可有效减少老年髋部骨折患者行THA的失血量,缩短住院时间,加速髋关节功能恢复。     

术前认知衰弱对老年髋部骨折术后患者关节功能影响的纵向研究

目的 探讨术前认知衰弱对老年髋部骨折患者术后不同时点关节功能的影响。方法 方便抽样法选取206例老年髋部骨折患者,采用一般资料调查表、FRAIL量表、简易精神状态检查量表及老年髋部骨折功能恢复量表进行调查,采用广义估计方程对老年髋部骨折患者术后3个月内不同时点关节功能进行影响因素分析。结果 老年髋部骨折患者认知衰弱发生率为38.3%。认知衰弱和非认知衰弱患者术后髋关节功能评分均随着时间的推移而有所改善,同一时点两组评分比较,差异有统计学意义(均P<0.05)。术前认知衰弱与不同时点老年髋部骨折功能评分呈负相关(均P<0.5)。广义估计方程分析结果显示,年龄、共病指数、美国麻醉医师协会分级、血钠、白蛋白、康复锻炼时间、术后时间和认知衰弱是术后髋关节功能的影响因素(均P<0.05)。结论 老年髋部骨折患者术前认知衰弱发生率高,对术后关节功能恢复存在负性影响,应注重术前认知衰弱评估,为衰弱预防和干预提供参考。     

Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation

We treated 108 patients with a pertrochanteric femoral fracture using either the dynamic hip screw or the proximal femoral nail in this prospective, randomised series. We compared walking ability before fracture, intra-operative variables and return to their residence. Patients treated with the proximal femoral nail (n = 42) had regained their pre-operative walking ability significantly (p = 0.04) more often by the four-month review than those treated with the dynamic hip screw (n = 41). Peri-operative or immediate post-operative measures of outcome did not differ between the groups, with the exception of operation time. The dynamic hip screw allowed a significantly greater compression of the fracture during the four-month follow-up, but consolidation of the fracture was comparable between the two groups. Two major losses of reduction were observed in each group, resulting in a total of four revision operations. Our results suggest that the use of the proximal femoral nail may allow a faster post-operative restoration of walking ability, when compared with the dynamic hip screw.     

Consequences of hip fracture on activities of daily life and residential needs

The aim of this study was to describe the consequences of hip fracture with respect to changes in residential needs and the ability to perform activities of daily life. Patients 50 years and older admitted to the two largest hospitals of Oslo with a hip fracture during the period May 1996 through April 1997 were identified. In November 1997 a questionnaire on residential needs, activities of daily life, hip pain and health status was sent to the patients still alive (n=767). After reminders, the questionnaires of 593 patients (77%) were included. Logistic regression analysis was applied to assess items associated with functional limitation and need for residential care. The proportion of patients living in nursing homes increased from 15% before to 30% after the hip fracture, and men were twice as likely to move into a nursing home than women. Of the patients living in their own homes before the hip fracture, 6% of those <75 years compared with 33% of those >85 years had to move to nursing home after hip fracture. The proportion of patients walking without any aid decreased from 76 to 36%, and 43% of the patients lost their pre-fracture ability to move outside on their own. More than a fourth of the patients (28%) lost their ability to cook their own dinner after sustaining hip fracture. The probability of these events increased with increasing age. The probability of reporting inferior health status and for having hip pain that affected sleep after the fracture was unrelated to age. Many patients sustaining a hip fracture, and in particular the oldest patients, have reduced ability to perform activities of daily life.     

超早期康复护理防治偏瘫患者肩手综合征效果观察

目的观察超早期康复护理对预防和治疗脑卒中偏瘫患者肩手综合征的作用.方法将238例脑卒中偏瘫患者随机分为康复组(122例)和对照组116例),两组均给予常规药物治疗和护理,康复组在此基础上予超早期康复护理,包括保持功能和做医疗体操和向心性缠绕压迫手指法、冷-温水交替浸泡法、上举患侧上肢、利用意念促使肢体功能恢复等多种康复训练措施.最后根据患者手指肿胀发生率、患手指肿胀程度以及简易手功能检查(STEE)评定康复效果.结果康复组患者肩手综合征发生率显著低于对照组(P<0.01);康复组治疗后较治疗前手指肿胀程度显著减轻(P<0.01);两组治疗后患肢运动功能均较前显著恢复(P<0.05,P<0.01),而康复组更显著(P<0.05).结论超早期康复护理对脑卒中偏瘫患者肩手综合征的预防和治疗具有积极的促进作用.     

不同康复训练治疗方式对跟腱断裂损伤修复术后运动功能恢复的影响

研究不同康复训练治疗方式对跟腱断裂损伤修复术后运动功能恢复的影响。方法 选取 2018年3月-2021年12月在常州第一人民医院行跟腱断裂损伤修复术的80例患者为研究对象，随机分为对 照组和研究组，每组40例。对照组采取传统康复治疗方式进行治疗，研究组采取加速康复治疗方式进行 治疗，比较两组临床疗效、FMI和Holden步行功能评分、血清VEGF和IL-6水平，并采用Pearson相关系 数分析血清EGF与IL-6的相关性。结果 研究组治疗后FMI和Holden步行功能评分均高于对照组，差异有 统计学意义（P ＜0.05）；研究组治疗总有效率（92.50%）高于对照组（80.00%），差异有统计学意义 （P ＜0.05）；研究组治疗后血清VEGF水平高于对照组，血清IL-6水平低于对照组，差异有统计学意义 （P ＜0.05）；两组治疗后血清VEGF和血清IL-6水平之间呈负相关（P ＜0.05）。结论 相对于传统RAT术 后康复治疗方式，加速康复治疗方式具有较好的疗效，且能更好地促进RAT患者术后运动功能的恢复。     

快速康复外科理念在闭合性跟骨骨折患者护理中的临床应用

［摘要］ 目的 探究快速康复外科理念（ERAS）在闭合性跟骨骨折患者护理中的应用效果。方法 选取本院2017年7月~2018年12月的全部闭合性跟骨骨折患者27名纳入ERAS系统的为ERAS组;2015年3月~2016年12月的全部30名闭合性跟骨骨折患者未进行ERAS管理的为传统组。其中传统组应用常规的围手术期护理,ERAS组应用ERAS快速外科理念对其进行干预护理。57例跟骨骨折患者均行手术治疗,其Sanders分型为Ⅱ型12例、Ⅲ型27例、Ⅳ型18例。对这57例闭合性跟骨骨折患者从术后疼痛评分、术后康复训练耐受时间、术后伤口肿胀消退时间、住院天数、住院费用、患者满意度等方面进行对比研究分析。结果 ERAS组术后1 d、3 d、1 w的疼痛评分均低于与传统组（P<0.05）;术后康复训练时间上ERAS组优于传统组（P<0.05）;术后肿胀消退时间ERAS组与传统组比较明显缩短（P<0.05）,住院天数上ERAS组短于传统组（P<0.05）,患者对护理满意度调查ERAS组评分高于传统组（P<0.01）。结论 ERAS快速康复外科理念在治疗闭合性跟骨骨折患者中能够降低住院天数,提高患者对护理治疗的满意度。     

Rehabilitation at home after hip fracture

Two series of patients with a hip fracture, sustained at home, were assessed regarding utilization of rehabilitation resources before and after adoption of an active policy favoring rehabilitation at home. Out of 86 consecutive patients in 1985 (Series I), 22 were discharged directly to their home versus 44 out of 84 in 1986 (Series II). Four months after the fracture, 57 and 63 of the surviving patients in Series I and II, respectively, were at home. Twenty of the 77 surviving patients in Series I were permanently institutionalized compared with 14 of 77 in Series II. We conclude that an active attitude towards home rehabilitation after a hip fracture benefits patients and the community alike.     

全髋关节置换术患者的康复护理

目的探讨人工全髋关节置换术前后早期进行科学功能康复训练的效果。方法制定一整套人工全髋关节置换术围手术期功能康复训练程序，掌握训练进度，采取尽早开始、循序渐进、个别对待、随时调整、持之以恒的原则。结果本组68例全髋关节置换术．髋关节功能按Charnley标准评分，疗效判定优31例，良18例，可15例，差4例，优良率72％。结论功能康复训练程序具有康复快、关节功能恢复效果好、并发症少的特点。     

Risk of mortality following hip fracture in Japan

Background Excessive mortality and morbidity are serious problems after hip fracture in the elderly. Methods Hip fractures in persons aged 50 years or older were prospectively registered in Japan in 2000. Questionnaires regarding both the first onset and the second 120-day period after hip fracture were obtained from 759 patients, 546 of whom were female and 213 male. Results Their average age at the time of fracture was 80 years. Altogether, 68 people (9%) died within 120 days after fracture; and 25 patients died within 30 days. Those dying within 120 days and those alive after hip fracture were compared. By univariate analysis, risk factors were poor walking ability, need for a walking aid, low body mass index, history of falls, and lack of active exercise; however, none of these factors was identified as a risk factor by multivariate analysis. By multivariate analysis, the five risk factors associated with mortality were male sex, older age, high American Academy of Anesthesiology (ASA) grade, dementia, and residence in an institution. Conclusions During the treatment and rehabilitation period special attention should be paid to patients with chronic diseases and reduced mental status.     

Rehabilitation following hand transplantation

Background

Hand allotransplantation can restore motor, sensory and cosmetic functions to upper extremity amputees. Over 70 hand transplant operations have been performed worldwide, but there is little published regarding post-hand transplant rehabilitation.

Methods

The Brigham and Women's Hospital (BWH) Hand Transplantation Team's post-hand transplant rehabilitation protocol is presented here. The protocol must be modified to address each transplant recipient's unique needs. It builds on universally used modalities of hand rehabilitation such as splinting, edema and scar management, range of motion exercises, activities of daily living training, electrical stimulation, cognitive training and strengthening.

Results

The BWH hand transplant rehabilitation protocol consists of four phases with distinct goals, frequency, and modalities. (1) Pre-operative: functional assessments are completed and goals and expectations of transplantation are established. (2) Initial post-operative (post-operative weeks 1–2): hand protection, minimization of swelling, education, and discharge. (3) Intermediate (post-operative weeks 2–8): therapy aims to prevent and/or decrease scar adhesion, increase tensile strength, flexibility and function, and prevent joint contractures. (4) Late (from 8 weeks forward): maximization of function and strength, and transition to routine activities. The frequency of rehabilitation therapy decreases gradually from the initial to late phases.

Conclusions

Rehabilitation therapy after hand transplantation follows a progressive increase in activity in parallel with wound healing and nerve regeneration. Careful documentation of progress and outcomes is essential to demonstrate the utility of interventions and to optimize therapy protocols.     

Acute cognitive dysfunction after hip fracture: frequency and risk factors in an optimized, multimodal, rehabilitation program

BACKGROUND: Patients undergoing hip fracture surgery often experience acute post-operative cognitive dysfunction (APOCD). The pathogenesis of APOCD is probably multifactorial, and no single intervention has been successful in its prevention. No studies have investigated the incidence of APOCD after hip fracture surgery in an optimized, multimodal, peri-operative rehabilitation regimen. METHODS: One hundred unselected hip fracture patients treated in a well-defined, optimized, multimodal, peri-operative rehabilitation regimen were included. Patients were tested upon admission and on the second, fourth and seventh post-operative days with the Mini Mental State Examination (MMSE) score. RESULTS: Thirty-two per cent of patients developed a significant post-operative cognitive decline, which was associated with several pre-fracture patient characteristics, including age and cognitive function, but also the number of peri-operative transfusions. The development of APOCD was also associated with impaired post-operative rehabilitation and an increased length of stay. APOCD was associated with the development of a major medical complication in 35% of all patients. In 65% of patients developing APOCD without a concomitant medical complication, the only risk factors were cognitive level and regular anti-psychotic treatment. CONCLUSION: On the basis of current evidence, APOCD is prevalent amongst hip fracture patients despite multimodal intervention; future research should therefore focus on defining subgroups of hip fracture patients amenable to specific prophylactic or interventional measures against APOCD.