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AAOS 2014:不稳定踝关节骨折术后早期活动功能良好

2014-02-26 佚名 丁香园

踝关节骨折内固定术后最佳踝关节活动范围及恰当负重原则目前尚无定论。一般认为踝关节应制动六周且避免负重,早期负重虽然可促进功能恢复但可能会导致内固定失败及引发伤口并发症。 为了探究早期负重是否有利于患者康复,加拿大皇家外科医师学会的Dehghan教授等进行了一项多中心随机对照研究。 该研究在两个一级创伤中心进行。纳入因不稳定型踝关节骨折进行急诊手术固定的患者,根据

踝关节骨折内固定术后最佳踝关节活动范围及恰当负重原则目前尚无定论。一般认为踝关节应制动六周且避免负重,早期负重虽然可促进功能恢复但可能会导致内固定失败及引发伤口并发症。

为了探究早期负重是否有利于患者康复,加拿大皇家外科医师学会的Dehghan教授等进行了一项多中心随机对照研究。

该研究在两个一级创伤中心进行。纳入因不稳定型踝关节骨折进行急诊手术固定的患者,根据不同的康复锻炼原则将其分为两组。早期负重组在术后两周开始活动踝关节并进行负重;延迟负重组术后六周内给予石膏固定并禁止负重。剔除伴有韧带联合损伤或后踝固定的患者。在术后的两周、六周、三个月、六个月及十二个月进行随访评估。

康复效果评价的主要标准包括:恢复骨工作的时间、踝关节活动范围、SF-36健康评分、Olerud/Molander踝关节功能评分、并发症的发生率(伤口并发症、复位失败、内固定失效及再次手术)。

结果共纳入了110例患者,56例患者进行早期负重,其余的患者进行延迟负重。患者的平均年龄为42岁,47%为女性,53%为男性。两组患者的人口统计学、骨折类型以及手术时机无统计学差异。

经过随访发现两组患者返回工作时间无差异,但在术后六周时与延迟负重组患者相比,早期活动组患者患者踝关节活动范围明显改善(42°vs 28°,p=0.001),Olerud/Molander踝关节功能评分明显提高(44 vs 31,p=0.001),SF-36评分亦较高:功能评分(44vs31,p=0.002)、精神评分(62vs54,p=0.005)。两组患者均未发生内固定失败、复位失败或再次手术。两组患者间伤口并发症或感染发生率亦无差异。

由该研究可知虽然两组患者返回工作的时间无差异,但是在早期进行提前踝关节活动患者踝关节功能明显改善、踝关节活动范围增加、身体及精神评分均有提高。所有患者均未发生内固定失败,伤口并发症发生率亦无差异。考虑到方便患者的日常生活,研究人员认为踝关节骨折术后应早期活动负重。

原始出处:

Niloofar Dehghan.Richard Jenkinson.Michael D. McKee.Aaron Nauth.Jeremy Hall.FRCS (ORTHO).David J. Stephen.Hans J. Kreder.Randomized Controlled Trial of Early vs Delayed Weightbearing After Surgical Fixation of Unstable Ankle Fractures.AAOS Mar 11, 2014

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    2014-06-20 yinhl1978
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    2014-02-28 qilu_qi
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