摘要
目的观察严重创伤后骨折卧床制动时间对骨折愈合时间的影响。方法选取2019年1~12月于南通大学附属建湖医院骨科接受手术治疗的107例严重创伤后骨折患者作为研究对象,采用随机数表法分为完全制动组36例,制动1周组36例和制动2周组35例。完全制动组即完全卧床制动,骨折断端完全固定,不鼓励早期进行活动;制动1周组和制动2周组则分别完全卧床制动1周和2周后,根据骨折类型给予不同方式的功能锻炼。分别于术前、术后1周、2周、5周、12周收集并比较各组患者的骨转换指标、骨密度指标及骨折愈合情况。结果(1)术后2周,制动1周组患者的β胶原特殊序列(β-CTX)明显低于完全制动组和制动2周组[(372.32±67.02)ng/L vs(398.73±56.59)ng/L vs(394.52±60.29)ng/L],Ⅰ型前胶原N端前肽(P1NP)明显高于完全制动组和制动2周组[(63.32±7.61)μg/L vs(50.58±5.33)μg/L vs(50.24±5.00)μg/L],差异均有统计学意义(P<0.05);术后5周,制动1周组、制动2周组及完全制动组患者的β-CTX逐渐升高[(276.64±56.66)ng/L vs(305.52±55.00)ng/L vs(351.69±55.21)ng/L],P1NP逐渐降低[(77.40±7.57)μg/L vs(64.34±6.40)μg/L vs(59.43±6.70)μg/L],两两比较差异均有统计学意义(P<0.05);术后12周,制动1周组和制动2周组患者的β-CTX明显低于完全制动组[(232.77±51.73)ng/L vs(235.61±51.74)ng/L vs(296.37±52.25)ng/L],P1NP明显高于完全制动组[(91.41±10.14)μg/L vs(93.29±10.16)μg/L vs(80.21±8.87)μg/L],差异均有统计学意义(P<0.05)。(2)术后2周,制动1周组患者的骨密度值和骨密度比率明显高于完全制动组和制动2周组[骨密度值:(0.43±0.14)g/cm^(2)vs(0.29±0.10)g/cm^(2)vs(0.36±0.12)g/cm^(2);骨密度比率:(0.76±0.28)%vs(0.62±0.25)%vs(0.58±0.22)%],差异均有统计学意义(P<0.05);术后5周,制动1周组和制动2周组骨密度值和骨密度比率明显高于完全制动组[骨密质值:(0.43±0.14)g/cm^(2)vs(0.36±0.12)g/cm^(2)vs(0.29±0.10)g/cm^(2);骨密度比率:(1.04±0.35)%vs(0.88±0.29)%vs(0.74±0.28)%],且制动1周组明显高于制动2周组,差异均有统计学意义(P<0.05);术后12周,制动1周组和制动2周组患者的骨密度值和骨密度比率高于完全制动组[骨密度值:(0.45±0.14)g/cm^(2)vs(0.45±0.14)g/cm^(2)vs(0.38±0.12)g/cm^(2);骨密度比率:(1.71±0.46)%vs(1.74±0.44)%vs(0.91±0.30)%],差异均具有统计学意义(P<0.05)。(3)术后2周,制动1周组患者的X线骨痂评分明显高于完全制动组和制动2周组[(0.94±0.42)分vs(0.67±0.35)分vs(0.74±0.37)分],差异均有统计学意义(P<0.05);术后5周,制动1周组和制动2周组患者的X线骨痂评分明显高于完全制动组[(2.00±0.52)分vs(1.60±0.45)分vs(1.30±0.43)分],且制动1周组明显高于制动2周组,差异均有统计学意义(P<0.05);术后12周,制动1周组和制动2周组患者的X线骨痂评分明显高于完全制动组[(2.78±0.57)分vs(2.74±0.55)分vs(1.83±0.49)分],差异均有统计学意义(P<0.05)。结论与完全卧床制动相比,制动1周或2周后开始进行细微活动可以改善严重创伤后骨折患者骨转换紊乱情况,提高骨折断端骨密度,更有利于骨折愈合,且制动1周开始进行细微活动在早期的促进效果更明显。
Objective To observe the influence of bed braking time on healing time of patients with fracture after severe trauma.Methods A total of 107 patients with severe post-traumatic fractures who received surgical treatment in Jianhu Hospital Affiliated to Nantong University from January 2019 to December 2019 were selected,and all subjects were divided into the complete braking group(36 cases),the braking 1 week group(36 cases),and the braking 2 weeks group(35 cases)by the random number table method.Patients in the complete braking group received complete bed brake,the fracture end was completely fixed,and early activity was not encouraged;patients in the braking 1 week group and the braking 2 weeks group received functional exercise in different ways according to the fracture types after complete bed braking 1 week or 2 weeks,respectively.The bone conversion indexes,bone mineral density indexes,and fracture healing indexes were collected and compared among the three groups at 1,2,5,and 12 weeks after surgery.Results(1)At 2 weeks after the operation,theβ-CTX was lower and the P1NP was higher in the braking 1 week group than those in the complete braking group and the braking 2 weeks group(P<0.05):β-CTX,(372.32±67.02)ng/L vs(398.73±56.59)ng/L vs(394.52±60.29)ng/L;P1NP,(63.32±7.61)μg/L vs(50.58±5.33)μg/L vs(50.24±5.00)μg/L.At 5 weeks after the operation,theβ-CTX was increased and the P1NP were decreased successively in the braking 1 week group,the braking 2 weeks group and the complete braking group,with statistically significant difference(P<0.05):β-CTX,(276.64±56.66)ng/L vs(305.52±55.00)ng/L vs(351.69±55.21)ng/L;P1NP,(77.40±7.57)μg/L vs(64.34±6.40)μg/L vs(59.43±6.70)μg/L.At 12 weeks after the operation,theβ-CTX were lower and P1NP were higher in the braking 1 week group and in the braking 2 weeks group than those in the complete braking group(P<0.05):β-CTX,(232.77±51.73)ng/L vs(235.61±51.74)ng/L vs(296.37±52.25)ng/L;P1NP,(91.41±10.14)μg/L vs(93.29±10.16)μg/L vs(80.21±8.87)μg/L.(2)At 2 weeks after the operation,the BMD value and BMD ratio was higher in the braking 1 week group than those in the complete braking group and in the braking 2 weeks group(P<0.05):BMD,(0.43±0.14)g/cm^(2) vs(0.29±0.10)g/cm^(2) vs(0.36±0.12)g/cm^(2);BMD ratio:(0.76±0.28)%vs(0.62±0.25)%vs(0.58±0.22)%.At 5 weeks after the operation,the BMD value and BMD ratio were higher in the braking 1 week group than those in the braking 2 weeks group and in the complete braking group(P<0.05):BMD,(0.43±0.14)g/cm^(2) vs(0.36±0.12)g/cm^(2) vs(0.29±0.10)g/cm^(2);BMD ratio:(1.04±0.35)%vs(0.88±0.29)%vs(0.74±0.28)%.At 12 weeks after the operation,the BMD value and BMD ratio were higher in the braking 1 week group and in the braking 2 weeks group than those in the complete braking group(P<0.05):BMD,(0.45±0.14)g/cm^(2) vs(0.45±0.14)g/cm^(2) vs(0.38±0.12)g/cm^(2);BMD ratio,(1.71±0.46)%vs(1.74±0.44)%vs(0.91±0.30)%.(3)At 2 weeks after the operation,the X-ray callus score was higher in the braking 1 week group than those in the complete braking group and the braking 2 weeks group:(0.94±0.42)points vs(0.67±0.35)points vs(0.74±0.37)points,P<0.05.At 5 weeks after the operation,the X-ray callus score was higher in the braking 1 week group and in the braking 2 weeks group than those in the complete braking group:(2.00±0.52)points vs(1.60±0.45)points vs(1.30±0.43)points,and the score in the braking 1 week group was higher than that in the braking 2 weeks group(P<0.05).At 12 weeks after the operation,the X-ray callus score were higher in the braking 1 week group and in the braking 2 weeks group than that in the complete braking group(P<0.05):(2.78±0.57)points vs(2.74±0.55)points vs(1.83±0.49)points.Conclusion Compared with complete braking,the braking 1 or 2 weeks can improve the bone conversion disorder,improve the bone density at the fracture end,and is more conducive to fracture healing in patients with severe post-traumatic fractures.Besides,the braking 1 week have a more obvious promoting effect in the early stage.
作者
李志云
董佩龙
LI Zhi-yun;DONG Pei-long(Department of Orthopaedics,Jianhu Hospital Affiliated to Nantong University,Yancheng 224700,Jiangsu,CHINA)
出处
《海南医学》
CAS
2023年第6期795-800,共6页
Hainan Medical Journal
基金
江苏省卫生计生委项目(编号:QNRC2016463)。
关键词
严重创伤后骨折
卧床时间
骨折愈合
康复运动
影响
Severe post-traumatic fractures
Time in bed
Fracture healing
Rehabilitation exercise
Effect
