运动疗法联合强骨饮口服在股骨转子间骨折术后康复中的应用

目的:探讨运动疗法联合强骨饮口服在股骨转子间骨折术后康复治疗中的疗效和安全性。方法:60例股骨转子间骨折术后患者,随机分为2组。治疗组32例,男10例,女22例;年龄60～89岁,中位数70.5岁。对照组28例,男7例,女21例;年龄61～87岁,中位数69.5岁。治疗组采用运动疗法联合强骨饮口服综合治疗,对照组仅采用运动疗法治疗。观察比较2组患者术后下床时间、骨折愈合、骨密度改善、髋关节功能及并发症发生情况。结果:60例患者均获随访,随访时间6～18个月,中位数12.5个月。治疗组术后下床时间为35～60 d,中位数47.5 d;对照组术后下床时间为50～80 d,中位数65.5 d,治疗组患者术后下床时间早于对照组(t=-8.900,P=0.000)。骨折均愈合;治疗组骨折愈合时间2～4个月,中位数3.5个月;对照组骨折愈合时间3～9个月,中位数6.5个月,治疗组骨折愈合时间短于对照组(t=-9.207,P=0.000)。治疗组切口感染1例,经换药及抗感染治疗半个月后切口愈合。对照组切口感染2例,经过换药及抗感染治疗1个月后切口愈合;肺部感染2例,经抗感染治疗后症状缓解;泌尿系感染1例,经抗感染治疗后症状缓解;下肢深静脉血栓1例,转入血管外科行手术治疗后症状缓解。2组术后并发症发生率比较,差异无统计学意义(χ2=3.241,P=0.072)。术前2组患者骨密度的差异无统计学意义(t=1.059,P=0.294);术后1年,治疗组骨密度高于对照组(t=2.607,P=0.012);2组患者骨密度均较治疗前改善,且治疗组改善优于对照组(t=13.639,P=0.000)。参照美国矫形外科研究院髋关节评价标准评定疗效,治疗组优20例,良8例,可4例;对照组优13例,良5例,可10例;治疗组疗效优于对照组(Z=-2.317,P=0.021)。结论:在转子间骨折的术后康复中应用运动疗法联合强骨饮口服,可提高骨密度,促进骨折愈合,缩短患者下地时间,有利于髋关节功能恢复,比单纯运动康复治疗疗效更显著,且不良反应少。

Application of exercise therapy combined with oral QIANG GU DRINK in the postoperative rehabilitation of femoral intertrochanteric fracture

Objective：To explore the curative effect and safety of exercise therapy combined with oral QIANG GU DRINK in the postoperative rehabilitation treatment of femoral intertrochanteric fracture.Methods：Sixty postoperative patients with femoral intertrochanteric fracture were randomly divided into 2 groups.Thirty-two patients was in the treatment group,male 10 cases,while female 22 cases,ranging in age from 60 to 89 years with a median of 70.5 years;while the others was in the control group,male 7 cases,while female 21 cases,ranging in age from 61 to 87 years with a median of 69.5 years.Patients in the treatment group were administrated with exercise therapy combined with oral QIANG GU DRINK,while the others in the control group were administrated with exercise therapy only.The bed rest time,fracture healing process,improvement of bone mineral density（BMD）,hip function and complications of patients were observed and compared between the 2 groups.Results：Sixty patients were all followed up,ranging in follow-up time from 6 to 18 months with a medium of 12.5 months.For patients in the treatment group,the bed rest time ranged from 35 to 60 days with a median of 47.5 days;while that time for cases in the control group ranged from 50 to 80 days with a median of 65.5 days;and the bed rest time for patients in the treatment group was shorter than that in the control group（t=-8.900,P=0.000）.The fractures were all healed.The fracture healing time of treatment group ranged from 2 to 4 months with a median of 3.5 months,while that time of control group ranged from 3 to 9 months with a median of 6.5 months,and the fracture healing time of treatment group was shorter than that of control group（t=-9.207,P=0.000）.One case with incision infection was found in treatment group and was healed after dressing change combined with anti-infective treatment for half of a month.For patients in the control group,2 cases with incision infection were found and were healed after dressing change combined with anti-infective treatment for 1 month;2 cases with pulmonary infection and 1 case with urinary infection were found,whose symptoms were alleviated after anti-infective treatment,and one case with deep venous thrombosis was found,whose symptom was alleviated after operative treatment in vascular surgery department.There was no statistical difference in postoperative complications between the 2 groups（χ2=3.241,P=0.072）.There was no statistical difference in BMD of patients between the 2 group before the treatment（t=1.059,P=0.294）;while BMD of treatment group was higher than that of control group 1 year after operation（t=2.607,P=0.012）.BMD of patients in the 2 groups increased after the treatment and the patients in the treatment group got more significant improvement in BMD compared with the patients in the control group（t=13.639,P=0.000）.The curative effect was evaluated according to evaluation criterion of hip junction of American Orthopaedic Academy.Twenty patients had excellent outcomes,8 patients had good outcomes and 4 patients had fair outcomes in the treatment group;while 13 patients had excellent outcomes,5 patients had good outcomes and 10 patients had fair outcomes in the control group;and the curative effect of treatment group was better than that of control group（Z=-2.317,P=0.021）.Conclusion：It can increase BMD,promote fracture healing and shorten the bed rest time by application of exercise therapy combined with oral QIANG GU DRINK in the postoperative rehabilitation of femoral intertrochanteric fracture,and it is beneficial for recovery of joint function of hip and has more significant curative effect and less adverse reactions.