肘关节粘连松解术后功能锻炼依从性及其影响因素的调查研究-现代医学

肘关节粘连松解术后功能锻炼依从性及其影响因素的调查研究

单位：1. 上海市第六人民医院东院骨科, 上海 200233;
2. 上海市第六人民医院东院护理部, 上海 200233

分类号：R684

出版年·卷·期（页码）：2017·36·第八期（1214-1218）

摘要：

目的：调查与探讨肘关节粘连松解术后患者的功能锻炼依从性及其影响因素。方法：采用方便抽样方法，2013年9月至2015年12月在我院诊断为创伤性肘关节粘连并接受肘关节粘连松解术治疗的患者130例作为研究对象，调查患者的临床一般资料、围手术指标与术后功能锻炼依从性情况，同时进行单因素与多因素分析。结果：130例患者身体锻炼依从评分为（22.54±4.29）分，术后注意事项依从评分为（6.45±2.19）分，主动寻求建议依从评分为（5.87±2.00）分；经过判定，功能锻炼依从性评分≥ 30分为112例，依从性为86.2%。单因素分析结果显示术后肿胀周径差、疼痛评分、冰敷、开始锻炼时间、合并糖尿病与肘关节粘连松解术后功能锻炼依从性明显相关（P<0.05）；多因素Logistic回归分析结果显示术后开始锻炼时间、冰敷、疼痛评分及肿胀周径差为影响肘关节粘连松解术后功能锻炼依从性的主要独立危险因素（P<0.05）。结论：肘关节粘连松解术后患者的功能锻炼依从性有待进一步提高，术后开始锻炼时间、冰敷、疼痛评分及肿胀周径差为主要的影响因素。

Objective: To investigate the functional exercise compliance and its influencing factors in patients after elbow joint lysis.Methods: Used the convenience sampling method, from September 2013 to December 2015, 130 patients with traumatic elbow adhesions were accepted elbow joint lysis in our hospital as the research subjects. The patients' clinical data, perioperative parameters and postoperative functional exercise compliance were collected and analyzed in single-and multiple-factor manner. Results: The physical exercise adherence scores in the 130 patients were 22.54±4.29 points, the postoperative compliance scores were 6.45±2.19 points, taking the initiative to seek advice compliance score were 5.87±2.00 points; After the judgment, 112 patients had the functional exercise compliance scores more than 30 points, the compliance was 86.2%. Single factor analysis showed that the diameter of postoperative swelling, pain score, ice compress, postoperative exercise time, diabetes were related to the functional exercise adherence(P<0.05); Logistic regression analysis showed that postoperative swelling, pain score, ice compress, postoperative exercise time were the main independent risks for the functional exercise adherence(P<0.05).Conclusion: The functional exercise compliance of the patients with elbow joint adhesion lysis needs to be further improved, and the main risk factors are the postoperative swelling, pain score, ice compress, postoperative exercise time.

参考文献：

[1] 汪亚兵,李伦兰,倪秀梅,等.改良式肩关节外展支具在关节镜下肩袖修补术后患者中的应用[J].中华护理杂志,2016,51(11):1361-1363.
[2] LAKE S P,CASTILE R M,BORINSKY S,et al.Development and use of an animal model to study post-traumatic stiffness and contracture of the elbow[J].J Orthop Res,2016,34(2):354-364.
[3] 蔺利朋,李铁,张健,等.铰链式外固定架结合开放手术治疗肘关节骨折术后僵硬的疗效[J].中国老年学杂志,2015,(11):3135-3136.
[4] PETERSON C L,ROGERS L M,BEDNAR M S,et al.Posture-dependent corticomotor excitability differs between the transferred biceps in individuals with tetraplegia and the biceps of nonimpaired individuals[J].Neurorehabil Neural Repair,2016,12(8):695-699.
[5] 邢丽娅,刘平,杨盛力,等.肘关节恐怖三联征的护理指导[J].护士进修杂志,2013,28(11):1014-1016.
[6] WILSON K W,DICKENS J F,HECKERT R,et al.Heterotopic ossification resection after open periarticular combat-related elbow fractures[J].J Surg Orthop Adv,2013,22(1):30-35.
[7] SHANKAR V,SHARMA P,MITTAL R,et al.Effectiveness of arthroscopic elbow synovectomy in rheumatoid arthritis patients:Long-term follow-up of clinical and functional outcomes[J].J Clin Orthop Trauma,2016,7(Suppl 2):230-235.
[8] 朱亚玲,钱宇,王海平.品管圈对提高骨科手术患者功能锻炼依从性的护理效果观察[J].中国现代医生,2016,54(5):137-140.
[9] KIM Y S,LEE H J,LEE D H,et al.Comparison of high and low dose intraarticular triamcinolone acetonide injection for treatment of primary shoulder stiffness:a prospective randomized trial[J].J Shoulder Elbow Surg,2016,46(16):30474-30478.
[10] 王桂娜,胡薇,卢秀萍.下肢功能锻炼袋在截瘫患者自主功能锻炼中的应用[J].中华护理杂志,2016,51(6):663-664.
[11] BOSTOCK E L,MORSE C I,WINWOOD K,et al.Omega-3 fatty acids and vitamin D in immobilisation:part B-modulation of muscle functional,vascular and activation profiles[J].J Nutr Health Aging,2017,21(1):59-66.
[12] SENEFELD J,YOON T,HUNTER S K.Age differences in dynamic fatigability and variability of arm and leg muscles:Associations with physical function[J].Exp Gerontol,2016,10(27):926-936.
[13] 蔺利朋,李铁,张健,等.铰链式外固定架结合开放手术治疗肘关节骨折术后僵硬的疗效[J].中国老年学杂志,2015,(11):3135-3136.
[14] ZWINGMANN J,NEUMANN M V,HAMMER T O,et al.Comminuted fracture of elbow-ostheosynthesis vs. total joint replacement[J].Acta Chir Orthop Traumatol Cech,2016,83(4):231-237.
[15] TARALLO L,MUGNAI R,ROCCHI M,et al.Mason type Ⅲ radial head fractures treated by anatomic radial head arthroplasty:Is this a safe treatment option?[J].Orthop Traumatol Surg Res,2016,68(16):30230-30234.
[16] 林光锚,刘良乐,叶丽洁,等.中医综合疗法预防肘关节三联征术后肘关节僵硬的病例对照研究[J].中国骨伤,2014,27(11):900-903.
[17] LANHERS C,PEREIRA B,GAY C,et al.Evaluation of the efficacy of a short-course,personalized self-management and intensive spa therapy intervention as active prevention of musculoskeletal disorders of the upper extremities(Muska):a research protocol for a randomized controlled trial[J].BMC Musculoskelet Disord,2016,17(1):497-504.
[18] 倪胜辉,郭磊,赵杰,等.肘关节切开粘连松解术治疗肘关节僵直疗效分析[J].中国矫形外科杂志,2013,21(24):2522-2524.
[19] VINCENT H K,STRUK A M,REED A,et al.Mid-term shoulder functional and quality of life outcomes after shoulder replacement in obese patients[J].Springerplus,2016,5(1):1929-1935.
[20] 李旭军,何宁,夏震,等.松解术治疗陈旧性肘部损伤"三联征"的疗效分析[J].中华创伤骨科杂志,2013,15(4):357-359.
[21] ORBAY J L,RING D,KACHOOEI A R,et al.Multicenter trial of an internal joint stabilizer for the elbow[J].J Shoulder Elbow Surg,2017,26(1):125-132.

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