Pilon骨折术后康复中阶梯式踝关节锻炼

目的评价阶梯式踝关节强化锻炼的方法在Pilon骨折术后踝关节功能康复中的临床疗效。方法回顾性分析2016年1月-2018年5月中部战区总医院收治的78例Pilon骨折术后患者的临床资料,男性61例,女性17例;平均年龄(48.9±12.1)岁。根据患者是否接受阶梯式踝关节强化锻炼,将患者分为强化组(48例)和常规组(30例)。两组患者均行骨折切开复位内固定术,术后均行常规康复训练。强化组患者除行常规康复训练外,于术后第4周开始行阶梯式强化训练。记录并比较两组患者的骨折临床愈合时间、踝关节屈伸活动度和美国足踝外科医师协会踝与后足功能评分(AOFAS评分)。结果强化组达到骨折临床愈合时间为(13.7±1.5)周,优于常规组(15.6±1.8)周(P<0.001);术后12周,强化组踝关节背伸角度为(12.1±3.4)°,显著大于常规组(9.2±2.6)°,P<0.001。但两组患者踝关节跖屈角度、AOFAS评分差异无统计学意义;术后24周强化组踝关节跖屈角度、背伸角度和AOFAS评分均优于常规组(31.4±4.6)°vs.(28.4±4.2)°(P=0.006)、(17.2±3.3)°vs.(12.9±2.7)°(P<0.001)、(88.1±5.2)分vs.(84.8±5.6)分(P=0.011)]。结论阶梯式的踝关节强化锻炼可以促进Pilon骨折术后临床愈合,改善踝关节活动度,提高患者满意度,具有良好的临床应用价值。

Effect of progressive ankle strengthening training on the rehabilitation of Pilon fracture

Objective To investigate the feasibility of progressive ankle strengthening training on the rehabilitation of Pilon fracture.Methods Clinical data of 78 cases of Pilon fractures from Jan.2016 to May 2018 were retrospectively analyzed.There were 61 males and 17 females,with an average age of(48.9±12.1)years.According to whether to receive progressive ankle strengthening training,those patients were divided into routine group(30 cases)and strengthening group(48 cases).All patients underwent open reduction and internal fixation of Pilon fracture and received conventional rehabilitation training.In addition,patients in strengthening group began progressive ankle strengthening training at the 4 th week after operation.The clinical healing time of fracture,ankle range of motions and ankle-hindfoot scale of American Orthopedic Foot and Ankle Society(AOFAS)were recorded,and the clinical effects of the two groups were compared.Results The clinical healing time of the strengthening group was(13.7±1.5)week,which was shorter than that of the routine group of(15.6±1.8)week(P<0.001).At the12 th week after operation,the ankle dorsiflexion range of the strengthening group was(12.1±3.4)°,which was significantly higher than that of the routine group(9.2±2.6)°(P<0.001),but there was no difference in the ankle plantar flexion range and AOFAS scores.At the 24 th week after operation,ankle plantar flexion range,ankle dorsiflexion flexion range and AOFAS scores in the strengthening group were better than those of the routine group(31.4±4.6)°vs.(28.4±4.2)°(P=0.006),(17.2±3.3)°vs.(12.9±2.7)°,(88.1±5.2)vs.(84.8±5.6)].Conclusion Progressive ankle strengthening exercise can promote the clinical healing,increase the ankle joint mobility and improve patient satisfaction,which is feasible for Pilon fracture rehabilitation.