四肢骨折术后的康复治疗进展
摘要
<正>从AO提出"复位、固定、康复治疗"的骨折手术治疗原则以来,手术和康复就是密不可分的两部分。临床上经常发现术后复片满意而患肢功能却不尽如人意,这和术后没有规范的康复治疗有很大关系。本文对四肢骨折术后常用的康复治疗方法和康复计划进行了综述。1康复目标Gimigliano~([1])把骨折术后康复的目标归纳为以下几点:(1)防止肌肉萎缩和关节挛缩;(2)恢复肌力和肌张力;(3)恢复关节活动度,改善患肢的自主性和可控性;
引文
[1]Gimigliano F,Iolascon G,Riccio I.Post-surgical rehabilitative approach to fragility fractures[J].Aging Clin Exp Res,2013,25(1):23-25.
[2]Ginn K A,Herbert R D,Khouw W,et al.A randomized,controlled clinical trial of a treatment for shoulder pain[J].Physical Therapy,1997,77(8):810-811.
[3]Brox J.Regional musculoskeletal conditions:shoulder pain[J].Best Practice and Research Clinical Rheumatology,2003,17(1):33-56.
[4]Diercks R L,Stevens M.Gentle thawing of the frozen shoulder:A prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years[J].J Shoulder Elbow Surg,2004,13(5):499-502.
[5]张惠.不同健康宣教方式对骨折患者康复结局的影响分析[J].吉林医学,2013,34(23):4856-4857.
[6]陈丽文.利用复诊手册和微信群开展骨科出院患者康复宣教工作的实践[J].中医药管理杂志,2016,24(21):131-132.
[7]归仙华.肱骨外科颈骨折术后肩关节功能康复护理进展[J].医学理论与实践,2015,28(11):1442-1445.
[8]Yang SD,Ning SH,Zhang LH,Zhang YZ,Ding WY,Yang DL.The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture:A retrospective case-control study[J].Medicine,2016,95(33):e4548.
[9]Onderko,Laura Lynn;Rehman,Saqib.Treatment of Articular Fractures with Continuous Passive Motion[J].Orthopedic Clinics of North America,2013,44(3):345-356.
[10]Hill AD,Palmer MJ,Tanner SL,et al.Use of Continuous Passive Motion in the Postoperative Treatment of Intra-Articular Knee Fractures[J].J Bone Joint Surg Am,2014,96(14):e118.
[11]Johnson AJ,Godges JJ,Zimmerman GJ,Ounanian LL.The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis[J].J Orthop Sports Phys Ther,2007,37(3):88-99.
[12]陆廷永,周元爱,韦贵武.关节松动术配合中药熏蒸促进胫骨平台骨折术后功能康复疗效观察[J].深圳中西医结合杂志,2015,25(18):38-39.
[13]乔冠儒,曹银吉,姜荣辉,等.肱尺关节分离技术对上肢骨折后肘关节功能障碍的疗效[J].中外医疗,2015,32(25):80-81.
[14]郑南国.小关节松动术在踝关节僵硬康复治疗中的应用观察[D].成都中医药大学,2015.
[15]燕铁斌.现代康复治疗技术[M].合肥:安徽科学技术出版社,1999:125-132.
[16]毛万姮,杨燕,田景亮.蜡疗配合关节松动术对膝关节周围骨折术后功能障碍的疗效分析[J].中国伤残医学,2014,22(5):3-5.
[17]凡铭光,何苗利.膝关节术后活动受限的康复治疗--关节松动术[J].运动,2015(11):151-151.
[18]王向红,郭伟韬,王辉.慢性等长收缩在骨折术后锻炼中的应用价值[J].现代中西医结合杂志,2008,17(34):5294-5295.
[19]Lebrun C T,Langford J R,Sagi H C.Functional outcomes after operatively treated patella fractures[J].Journal of Orthopaedic Trauma,2012,26(7):422-426.
[20]Paul DJ,Nassis GP.Testing Strength and Power in Soccer Players:the Application of Conventional and Traditional Methods of Assessment[J].Strength Cond Res,2015,29(6):1748-1758.
[21]张勇,宋宇锋,赵斌.等速训练测试系统在髌骨骨折患者早期康复训练中的疗效[J].山西职工医学院学报,2016,26(1):26-28.
[22]Costantino C,Verdano M A,Jacopetti M,et al.Isokinetic strength test and functional outcomes in proximal humeral fractures treated with a locking plate[J].Journal of Orthopaedic Science,2014,19(5):776-785.
[23]Verdano MA,Baudi P,Pellegrini A,et al.Strength recovery after proximal humeral fractures treated with locking plate[J].Musculoskelet Surg,2014,98(1):S61-S69.
[24]Cook JJ,Summers NJ,Cook EA.Healing in the new millennium:bone stimulators:an overview of where we've been and where we may be heading[J].Clin Podiatr Med Surg,2015,32(1):45-59.
[25]Griffin M,Bayat A.Electrical stimulation in bone healing:critical analysis by evaluating levels of evidence.[J].Eplasty,2011,11(11):e34.
[26]Steve Hodgson.Proximal Humerus Fracture Rehabilitation[J].Clinical Orthopaedics and Related Research,2006,442:131-138.
[27]Hernandez M,Rivkin G,Leibner ED,et al.Prevention of immobilization related muscular atrophy using the Myospare device:a controlled,randomized,open study to investigate the feasibility,safety and efficacy of electrical gastrocnemius stimulation in ankle fractures[J].Journal of Bone and Joint Surgery,2006,88(2):333-334.
[28]Harrison A,Lin S,Pounder N,et al.Mode&mechanism of low intensity pulsed ultrasound(LIPUS)in fracture repair[J].Ultrasonics,2016,70:45-52.
[29]Zura R,Mehta S,Rocca G J D,et al.A cohort study of 4,190patients treated with low-intensity pulsed ultrasound(LIPUS):findings in the elderly versus all patients[J].Bmc Musculoskeletal Disorders,2015,16(1):1-10.
[30]Aleem IS,Bhandari M.Cochrane in CORR:Ultrasound and Shockwave Therapy for Acute Fractures in Adults(Review)[J].Clinical Orthopaedics and Related Research,2016,474(7):1553-1559.
[31]Sella V,do Bomfim F,Machado PC,et al.Effect of low-level laser therapy on bone repair:a randomized controlled experimental study[J].Lasers Med Sci,2015,30(3):1061-1068.
[32]Mostafavinia A,Masteri Farahani R,Abbasian M,et al.Effect of Pulsed Wave Low-Level Laser Therapy on Tibial Complete Osteotomy Model of Fracture Healing With an Intramedullary Fixation[J].Iran Red Crescent Med J,2015,17(12):e32076.
[33]Nesioonpour S,Mokmeli S,Vojdani S,et al.The effect of lowlevel laser on postoperative pain after tibial fracture surgery:a double-blind controlled randomized clinical tria[J]l.Anesth Pain Med,2014,4(3):e17350.
[34]Kelsey J L,Browner W S,Seeley D G,et al.Risk Factors for Fractures of the Distal Forearm and Proximal Humerus[J].American Journal of Epidemiology,1992,135(5):477.
[35]Sun H L,Patricia D P D,Bréart G.Risk Factors for Fractures of the Proximal Humerus:Results From the EPIDOS Prospective Study[J].Journal of Bone&Mineral Research,2002,17(5):817-825.
[36]邱卓刚.本体感觉与软组织损伤的恢复[J].中国康复理论与实践,2004,10(5):295-296.
[37]谢东风,李奎,李鑫,等.本体感觉训练在膝关节周围骨折术后导致关节僵硬患者康复治疗中的作用[J].中国康复医学杂志,2013,27(10):945-947.
[38]张建华.本体感觉训练在踝关节僵硬康复治疗中的临床疗效观察[D].成都中医药大学,2015.
[39]陈黎,钟孝政,罗永雪,等.外踝骨折合并内侧副韧带损伤的治疗[J].中国骨与关节损伤杂志,2016,31(10):1053-1055.
[40]da Silva MD,Bobinski F,Sato KL,et al.IL-10ctokine released from M2macrophages is crucial for analgesic and anti-inflammatory effects of acupuncture in a model of inflammatory muscle pain[J].Mol Neurobiol,2015,51(1):19-31.
[41]Chen CC,Yang CC,Hu CC,et al.Acupuncture for pain relief after total knee arthroplasty:a randomized controlled trial[J].Reg Anesth Pain Med,2015,40(1):31-36.
[41]de Almeida Mdos S,de Freitas KM,Oliveira LP,et al.Acupuncture increases the diameter and reorganization of collagen fibrils during rat tendon healing[J].Acupunct Med,2015,33(1):51-57.
[42]刘光宇,刘涛.针灸联合常规训练应用于胫骨平台骨折术后康复中的临床意义[J].现代中西医结合杂志,2015,24(7):757-759.
[43]毛华晋,凃刚城,邱静,等.桃红四物汤对股骨干骨折术后炎性因子和血液流变学的影响[J].南京中医药大学学报,2016,32(5):419-422.
[44]Chen JH,Liu C,Simmons CA,et al.Boning up on Wolff's Law:mechanical regulation of the cells that make and maintain bone[J].J Biomech,2010,43(1):108-118.
[45]Amaha K,Arimoto T,Saito M,et al.Shorter recovery can be achieved from using walking boot after operative treatment of an ankle fracture:[J].Asia-Pacific Journal of Sports Medicine,Arthroscopy,Rehabilitation and Technology,2017,7(C):10-14.
[46]Fattoretto D,Borgo A,Iacobellis C.The treatment of complex proximal humeral fractures:analysis of the results of 55cases treated with PHILOS plate[J].Musculoskelet Surg,2016,100(2):109-114.
[47]Kelley MJ,Shaffer MA,Kuhn JE,et al.Shoulder pain and mobility deficits:adhesive capsulitis[J].Journal of Orthopaedic and Sports Physical Therapy,2013,43(5):A1-31.
[48]Waterbury K,Husband J,Callinan N,et al.An Accelerated Rehabilitation Protocol for Patients With Distal Radius Fracture Treated With Open Reduction Internal Fixation Using Volar Locking Plate,A Retrospective Review and Comparison of Outcomes With a Surgeon Directed Independent Exercise Program[J].Journal of Hand Therapy,2016,29(3):372-373.
[49]王海龙,覃鼎文,郭险峰.跟骨骨折术后系统康复治疗的临床疗效观察[J].中国康复医学杂志,2011,26(3):254-256.
[50]Clavert P,Adam P,Bevort A,et al.Pitfalls and complications with locking plate for proximal humerus fracture[J].J Shoulder Elbow Surg,2010,19(4):489-494.
[51]Liew AS,Johnson JA,Patterson SD,et al.Effect of screw placement on fixation in the humeral head[J].J Shoulder Elbow Surg,2000,9(5):423-426.
[52]武京伟,沈惠良,刘利民,等.PHILOS钢板治疗肱骨近端骨折早期内固定失效原因[J].北京大学学报(医学版),2016,48(4):683-685.
[53]Lee CW,Shin SJ.Prognostic factors for unstable proximal humeral fractures treated with locking-plate fixation[J].J Shoulder Elbow Surg,2009,18(1):83-88.
[54]戴闽,帅浪,范红先,等.骨折术后运动康复安全评定的几点体会[J].医学与哲学:临床决策论坛版,2010,31(5):34-36.
[55]万细珍,戴闽,张斌,等.运动康复与骨折治疗一体化对肱骨远端骨折术后疗效的影响[J].南昌大学学报(医学版),2011,51(11):10-13.
[2]Ginn K A,Herbert R D,Khouw W,et al.A randomized,controlled clinical trial of a treatment for shoulder pain[J].Physical Therapy,1997,77(8):810-811.
[3]Brox J.Regional musculoskeletal conditions:shoulder pain[J].Best Practice and Research Clinical Rheumatology,2003,17(1):33-56.
[4]Diercks R L,Stevens M.Gentle thawing of the frozen shoulder:A prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years[J].J Shoulder Elbow Surg,2004,13(5):499-502.
[5]张惠.不同健康宣教方式对骨折患者康复结局的影响分析[J].吉林医学,2013,34(23):4856-4857.
[6]陈丽文.利用复诊手册和微信群开展骨科出院患者康复宣教工作的实践[J].中医药管理杂志,2016,24(21):131-132.
[7]归仙华.肱骨外科颈骨折术后肩关节功能康复护理进展[J].医学理论与实践,2015,28(11):1442-1445.
[8]Yang SD,Ning SH,Zhang LH,Zhang YZ,Ding WY,Yang DL.The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture:A retrospective case-control study[J].Medicine,2016,95(33):e4548.
[9]Onderko,Laura Lynn;Rehman,Saqib.Treatment of Articular Fractures with Continuous Passive Motion[J].Orthopedic Clinics of North America,2013,44(3):345-356.
[10]Hill AD,Palmer MJ,Tanner SL,et al.Use of Continuous Passive Motion in the Postoperative Treatment of Intra-Articular Knee Fractures[J].J Bone Joint Surg Am,2014,96(14):e118.
[11]Johnson AJ,Godges JJ,Zimmerman GJ,Ounanian LL.The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis[J].J Orthop Sports Phys Ther,2007,37(3):88-99.
[12]陆廷永,周元爱,韦贵武.关节松动术配合中药熏蒸促进胫骨平台骨折术后功能康复疗效观察[J].深圳中西医结合杂志,2015,25(18):38-39.
[13]乔冠儒,曹银吉,姜荣辉,等.肱尺关节分离技术对上肢骨折后肘关节功能障碍的疗效[J].中外医疗,2015,32(25):80-81.
[14]郑南国.小关节松动术在踝关节僵硬康复治疗中的应用观察[D].成都中医药大学,2015.
[15]燕铁斌.现代康复治疗技术[M].合肥:安徽科学技术出版社,1999:125-132.
[16]毛万姮,杨燕,田景亮.蜡疗配合关节松动术对膝关节周围骨折术后功能障碍的疗效分析[J].中国伤残医学,2014,22(5):3-5.
[17]凡铭光,何苗利.膝关节术后活动受限的康复治疗--关节松动术[J].运动,2015(11):151-151.
[18]王向红,郭伟韬,王辉.慢性等长收缩在骨折术后锻炼中的应用价值[J].现代中西医结合杂志,2008,17(34):5294-5295.
[19]Lebrun C T,Langford J R,Sagi H C.Functional outcomes after operatively treated patella fractures[J].Journal of Orthopaedic Trauma,2012,26(7):422-426.
[20]Paul DJ,Nassis GP.Testing Strength and Power in Soccer Players:the Application of Conventional and Traditional Methods of Assessment[J].Strength Cond Res,2015,29(6):1748-1758.
[21]张勇,宋宇锋,赵斌.等速训练测试系统在髌骨骨折患者早期康复训练中的疗效[J].山西职工医学院学报,2016,26(1):26-28.
[22]Costantino C,Verdano M A,Jacopetti M,et al.Isokinetic strength test and functional outcomes in proximal humeral fractures treated with a locking plate[J].Journal of Orthopaedic Science,2014,19(5):776-785.
[23]Verdano MA,Baudi P,Pellegrini A,et al.Strength recovery after proximal humeral fractures treated with locking plate[J].Musculoskelet Surg,2014,98(1):S61-S69.
[24]Cook JJ,Summers NJ,Cook EA.Healing in the new millennium:bone stimulators:an overview of where we've been and where we may be heading[J].Clin Podiatr Med Surg,2015,32(1):45-59.
[25]Griffin M,Bayat A.Electrical stimulation in bone healing:critical analysis by evaluating levels of evidence.[J].Eplasty,2011,11(11):e34.
[26]Steve Hodgson.Proximal Humerus Fracture Rehabilitation[J].Clinical Orthopaedics and Related Research,2006,442:131-138.
[27]Hernandez M,Rivkin G,Leibner ED,et al.Prevention of immobilization related muscular atrophy using the Myospare device:a controlled,randomized,open study to investigate the feasibility,safety and efficacy of electrical gastrocnemius stimulation in ankle fractures[J].Journal of Bone and Joint Surgery,2006,88(2):333-334.
[28]Harrison A,Lin S,Pounder N,et al.Mode&mechanism of low intensity pulsed ultrasound(LIPUS)in fracture repair[J].Ultrasonics,2016,70:45-52.
[29]Zura R,Mehta S,Rocca G J D,et al.A cohort study of 4,190patients treated with low-intensity pulsed ultrasound(LIPUS):findings in the elderly versus all patients[J].Bmc Musculoskeletal Disorders,2015,16(1):1-10.
[30]Aleem IS,Bhandari M.Cochrane in CORR:Ultrasound and Shockwave Therapy for Acute Fractures in Adults(Review)[J].Clinical Orthopaedics and Related Research,2016,474(7):1553-1559.
[31]Sella V,do Bomfim F,Machado PC,et al.Effect of low-level laser therapy on bone repair:a randomized controlled experimental study[J].Lasers Med Sci,2015,30(3):1061-1068.
[32]Mostafavinia A,Masteri Farahani R,Abbasian M,et al.Effect of Pulsed Wave Low-Level Laser Therapy on Tibial Complete Osteotomy Model of Fracture Healing With an Intramedullary Fixation[J].Iran Red Crescent Med J,2015,17(12):e32076.
[33]Nesioonpour S,Mokmeli S,Vojdani S,et al.The effect of lowlevel laser on postoperative pain after tibial fracture surgery:a double-blind controlled randomized clinical tria[J]l.Anesth Pain Med,2014,4(3):e17350.
[34]Kelsey J L,Browner W S,Seeley D G,et al.Risk Factors for Fractures of the Distal Forearm and Proximal Humerus[J].American Journal of Epidemiology,1992,135(5):477.
[35]Sun H L,Patricia D P D,Bréart G.Risk Factors for Fractures of the Proximal Humerus:Results From the EPIDOS Prospective Study[J].Journal of Bone&Mineral Research,2002,17(5):817-825.
[36]邱卓刚.本体感觉与软组织损伤的恢复[J].中国康复理论与实践,2004,10(5):295-296.
[37]谢东风,李奎,李鑫,等.本体感觉训练在膝关节周围骨折术后导致关节僵硬患者康复治疗中的作用[J].中国康复医学杂志,2013,27(10):945-947.
[38]张建华.本体感觉训练在踝关节僵硬康复治疗中的临床疗效观察[D].成都中医药大学,2015.
[39]陈黎,钟孝政,罗永雪,等.外踝骨折合并内侧副韧带损伤的治疗[J].中国骨与关节损伤杂志,2016,31(10):1053-1055.
[40]da Silva MD,Bobinski F,Sato KL,et al.IL-10ctokine released from M2macrophages is crucial for analgesic and anti-inflammatory effects of acupuncture in a model of inflammatory muscle pain[J].Mol Neurobiol,2015,51(1):19-31.
[41]Chen CC,Yang CC,Hu CC,et al.Acupuncture for pain relief after total knee arthroplasty:a randomized controlled trial[J].Reg Anesth Pain Med,2015,40(1):31-36.
[41]de Almeida Mdos S,de Freitas KM,Oliveira LP,et al.Acupuncture increases the diameter and reorganization of collagen fibrils during rat tendon healing[J].Acupunct Med,2015,33(1):51-57.
[42]刘光宇,刘涛.针灸联合常规训练应用于胫骨平台骨折术后康复中的临床意义[J].现代中西医结合杂志,2015,24(7):757-759.
[43]毛华晋,凃刚城,邱静,等.桃红四物汤对股骨干骨折术后炎性因子和血液流变学的影响[J].南京中医药大学学报,2016,32(5):419-422.
[44]Chen JH,Liu C,Simmons CA,et al.Boning up on Wolff's Law:mechanical regulation of the cells that make and maintain bone[J].J Biomech,2010,43(1):108-118.
[45]Amaha K,Arimoto T,Saito M,et al.Shorter recovery can be achieved from using walking boot after operative treatment of an ankle fracture:[J].Asia-Pacific Journal of Sports Medicine,Arthroscopy,Rehabilitation and Technology,2017,7(C):10-14.
[46]Fattoretto D,Borgo A,Iacobellis C.The treatment of complex proximal humeral fractures:analysis of the results of 55cases treated with PHILOS plate[J].Musculoskelet Surg,2016,100(2):109-114.
[47]Kelley MJ,Shaffer MA,Kuhn JE,et al.Shoulder pain and mobility deficits:adhesive capsulitis[J].Journal of Orthopaedic and Sports Physical Therapy,2013,43(5):A1-31.
[48]Waterbury K,Husband J,Callinan N,et al.An Accelerated Rehabilitation Protocol for Patients With Distal Radius Fracture Treated With Open Reduction Internal Fixation Using Volar Locking Plate,A Retrospective Review and Comparison of Outcomes With a Surgeon Directed Independent Exercise Program[J].Journal of Hand Therapy,2016,29(3):372-373.
[49]王海龙,覃鼎文,郭险峰.跟骨骨折术后系统康复治疗的临床疗效观察[J].中国康复医学杂志,2011,26(3):254-256.
[50]Clavert P,Adam P,Bevort A,et al.Pitfalls and complications with locking plate for proximal humerus fracture[J].J Shoulder Elbow Surg,2010,19(4):489-494.
[51]Liew AS,Johnson JA,Patterson SD,et al.Effect of screw placement on fixation in the humeral head[J].J Shoulder Elbow Surg,2000,9(5):423-426.
[52]武京伟,沈惠良,刘利民,等.PHILOS钢板治疗肱骨近端骨折早期内固定失效原因[J].北京大学学报(医学版),2016,48(4):683-685.
[53]Lee CW,Shin SJ.Prognostic factors for unstable proximal humeral fractures treated with locking-plate fixation[J].J Shoulder Elbow Surg,2009,18(1):83-88.
[54]戴闽,帅浪,范红先,等.骨折术后运动康复安全评定的几点体会[J].医学与哲学:临床决策论坛版,2010,31(5):34-36.
[55]万细珍,戴闽,张斌,等.运动康复与骨折治疗一体化对肱骨远端骨折术后疗效的影响[J].南昌大学学报(医学版),2011,51(11):10-13.