吴锡娣 施翠敏 顾冬梅 梁少颖 陆青秀 韦金凤 许晓娴 李春容

【摘要】 目的 探讨早期活动方案对高龄股骨转子间骨折患者护理康复的应用效果。

方法 选取2018年9月至2020年9月住院治疗的高龄股骨转子间骨折患者84例，随机分为试验组和对照组，各42例。试验组按早期活动方案进行护理康复，对照组按常规活动方案进行护理康复，两组均随访6～12个月，比较两组病例下地活动时间、术后第3天可行走的距离（助行器辅助下）、住院时间、出院时的日常生活能力、术后3个月及6个月Harris髋关节功能评分。

结果 所有病例平均获得（8.2±1.7）个月的随访，试验组首次下地活动时间、术后第3天可行走的距离、住院时间、出院时ADL评分分别为（1.6±0.7） d、（41.4±25.8） m、（7.9±1.5） d、（76.1±6.8）分，与对照组的（2.4±0.9） d、（13.5±11.2） m、（10.7±2.4） d、（68.9±5.9）分比较，差异有统计学意义（P<0.01）;试验组和对照组出院时的护理满意度分别为97.6%、81.0%，差异有统计学意义（P<0.05）;术后3个月，试验组和对照组髋关节功能Harris评分优良率分别为66.7%、45.2%，差异有统计学意义（P<0.05）;术后6个月，试验组和对照组髋关节功能Harris评分优良率分别为88.1%、81.0%，差异无统计学意义（P>0.05）。

结论 有效的康复方案是决定高龄股骨转子间骨折患者術后髋关节功能恢复的关键，而早期活动方案有助于高龄股骨转子间骨折患者早期功能的恢复，提高患者的护理满意度和早期生活质量。

【关键词】 早期活动;高龄;股骨转子间骨折;护理康复

中图分类号：R683.42;R473.6   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.03.006

Study on application of early activity program in nursing rehabilitation of elderly patients with femoral intertrochanteric fracture

WU Xidi， SHI Cuimin， GU Dongmei， LIANG Shaoying， LU Qingxiu， WEI Jinfeng， XU Xiaoxian， LI Chunrong

（Orthopedics Department of Trauma and Sports， People's Hospital of Guigang City， Guigang 537100， Guangxi， China）

【Abstract】 Objective To explore the effect of early activity program on nursing rehabilitation of elderly patients with femoral intertrochanteric fracture.

Methods 84 elderly patients with femoral intertrochanteric fracture who were hospitalized from September 2018 to September 2020 were randomly divided into experimental group and control group， with 42 cases in each group. The experimental group received nursing rehabilitation according to early activity plan， while the control group received nursing rehabilitation according to routine activity plan. Both groups were followed up for 6-12 months. And then， the start time of ground movement， walking distance on the third day after operation （assisted by walking aid）， length of hospital stay， ability of daily living at discharge， Harris hip function score of 3 and 6 months after operation were compared between the two groups.

Results All patients were followed up for （8.2 ± 1.7） months on average. The start time of ground movement， walking distance on the third day after operation， length of hospital stay， ability of daily living （ADL） at discharge in the experimental group were （1.6±0.7） d， （41.4±25.8） m， （7.9±1.5） d and （76.1±6.8） points， respectively， while compared with those of the control group （ [2.4±0.9] d， [13.5±11.2] m， [10.7±2.4] d， [68.9±5.9] points）， difference was statistically significant （P < 0.01）. The nursing satisfaction of the experimental group and the control group at discharge were 97.6% and 81.0%， respectively， and difference was statistically significant （P < 0.05）. 3 months after operation， the excellent and good rate of Harris score of hip joint function in the experimental group and the control group were 66.7% and 45.2%， respectively， and difference was statistically significant （P < 0.05）. 6 months after operation， the excellent and good rate of Harris score of hip joint function in the experimental group and the control group were 88.1% and 81.0%， respectively， and difference was not statistically significant （P > 0.05）.

Conclusion Effective rehabilitation program is the key to determine the functional recovery of hip joint in elderly patients with femoral intertrochanteric fracture， and early activity program is helpful to the early functional recovery of the patients， and improve the nursing satisfaction and early quality of life of them.

【Key words】 early activity; elderly patients; femoral intertrochanteric fracture; nursing rehabilitation

随着我国人口老龄化的发展，股骨转子间骨折在老年人群中的發生率日益升高，约占老年髋关节骨折的44.1%，而高龄老年患者（年龄≥80岁）约占50%[1～2]。对于高龄股骨转子间骨折患者，长时间卧床易发生肺炎、泌尿系统感染、下肢深静脉血栓形成、褥疮等并发症，甚至危及生命[3～4]。研究表明，高龄髋关节骨折患者术后首次下地活动的时间为3～14 d，术后30 d及1年的死亡率分别为5%～10%、20%～30%，术后丧失独立行走能力约为53%[5～7]。……