摘要
目的:探讨脐灸联合多组分运动方案对老年股骨转子间骨折伴衰弱患者围术期康复质量的影响,为优化临床康复护理路径提供循证依据。方法:采用类实验研究设计,便利抽样选取2024年1月至2024年10月郑州市骨科医院收治的老年股骨转子间骨折伴衰弱患者,根据入院时间分为常规护理组、脐灸组(常规护理+脐灸)、运动组(常规护理+多组分运动)及联合组(常规护理+脐灸联合多组分运动),每组31例。均在麻醉下行股骨近端防旋髓内钉内固定术。脐灸方案以神阙穴为核心,结合补益肝肾中药粉,每次20 min;多组分运动分阶段设计,涵盖抗阻、平衡及有氧训练。比较4组术前和术后1、3个月及末次随访时Harris髋关节功能评分(HHS)、Tilburg衰弱量表(TFI)评分、国际版跌倒效能量表(FES-I)评分及中文版健康调查简表(SF-36)评分。结果:共纳入老年股骨转子间骨折伴衰弱患者124例,其中男50例,女74例;年龄60~80岁[(71.8±5.0)岁]。患者均获随访6个月。广义估计方程结果显示,术前和术后1、3个月及末次随访时,4组HHS、TFI评分、FES-I评分及SF-36评分比较,组间效应、时间效应及交互效应差异均有统计学意义(P<0.05)。简单效应分析结果显示,4组术前HHS、TFI总分、FES-I评分及SF-36评分差异均无统计学意义(P>0.05);术后1、3个月,HHS脐灸组分别为(54.3±5.1)分、(65.7±6.3)分,运动组分别为(61.3±5.3)分、(74.5±6.8)分,联合组分别为(66.5±5.2)分、(86.3±6.7)分,均高于常规护理组的(50.2±4.5)分、(60.7±5.1)分(P<0.05),且联合组高于脐灸组和运动组(P<0.05)。末次随访时,常规护理组HHS为(77.3±6.0)分,脐灸组为(77.0±5.9)分(P>0.05);运动组为(83.8±4.7)分,联合组为(91.4±3.5)分,均高于常规护理组(P<0.05),且联合组高于脐灸组和运动组(P<0.05)。术后1、3个月及末次随访时,脐灸组TFI总分分别为5.0(3.0,7.0)分、3.0(1.0,5.0)分、3.0(0.0,4.0)分,运动组分别为4.0(1.0,6.0)分、2.0(0.0,5.0)分、2.0(0.0,3.0)分,联合组分别为2.0(0.0,5.0)分、1.0(0.0,2.0)分、0.0(0.0,1.0)分,均低于常规护理组的7.0(5.0,10.0)分、7.0(5.0,9.0)分、6.0(5.0,8.0)分(P<0.05),且联合组低于脐灸组和运动组(P<0.05)。术后1、3个月及末次随访时,脐灸组、运动组和联合组TFI躯体维度及社会维度评分较常规护理组均降低(P<0.05),且联合组低于脐灸组和运动组(P<0.05)。术后1个月,4组TFI心理维度评分差异均无统计学意义(P>0.05)。术后3个月及末次随访时,脐灸组、运动组和联合组TFI心理维度评分较常规护理组均降低(P<0.05),且联合组低于脐灸组和运动组(P<0.05)。术后1、3个月及末次随访时,脐灸组FES-I评分分别为(45.3±4.3)分、(40.9±3.9)分、(33.9±2.8)分,运动组分别为(38.7±3.8)分、(32.9±3.6)分、(30.3±2.2)分,联合组分别为(34.2±3.6)分、(30.2±2.6)分、(27.9±1.3)分,均低于常规护理组的(50.9±4.9)分、(50.0±4.9)分、(40.7±4.2)分(P<0.05),且联合组低于脐灸组和运动组(P<0.05)。术后1、3个月及末次随访时,脐灸组SF-36躯体健康评分分别为(60.6±3.7)分、(76.1±3.5)分、(78.4±2.6)分,运动组分别为(57.6±3.7)分、(78.4±3.7)分、(80.4±3.1)分,联合组分别为(65.7±3.1)分、(85.9±2.9)分、(87.4±2.2)分,均高于常规护理组的(47.5±4.6)分、(65.9±4.6)分、(68.3±4.4)分(P<0.05),且联合组高于脐灸组和运动组(P<0.05)。术后1、3个月及末次随访时,脐灸组SF-36心理健康评分分别为(59.7±4.1)分、(74.5±3.6)分、(76.2±3.0)分,运动组分别为(59.4±4.6)分、(74.1±3.8)分、(74.4±3.9)分,联合组分别为(66.9±4.1)分、(81.6±3.3)分、(79.9±3.7)分,均高于常规护理组的(52.8±5.2)分、(64.0±4.9)分、(65.3±5.1)分(P<0.05),且联合组高于脐灸组和运动组(P<0.05)。结论:对于老年股骨转子间骨折伴衰弱患者,脐灸联合多组分运动方案可显著改善髋关节功能、降低衰弱程度及跌倒风险,并提高生活质量。
Objective:To explore the effects of umbilical moxibustion combined with a multi-component exercise program on perioperative rehabilitation in frail elderly patients with intertrochanteric fractures so as to provide evidence-based basis for optimizing clinical rehabilitation nursing pathways.Methods:A quasi-experimental study design was used.Convenience sampling was applied to frail select elderly patients with intertrochanteric femoral fractures,who were admitted to Zhengzhou Orthopedic Hospital from January to October 2024.According to their admission time,the patients were divided into four groups:conventional nursing group,umbilical moxibustion group(conventional nursing+umbilical moxibustion),exercise group(conventional nursing+multicomponent exercise),and combination group(conventional nursing+umbilical moxibustion combined with multicomponent exercise),with 31 patients in each group.All the patients underwent internal fixation with proximal femoral nail antirotation under anesthesia.The umbilical moxibustion protocol focused on Shenque acupoint,combined with liver-kidney-nourishing Chinese herbal powder,with each session lasting 20 minutes.The multi-component exercise program was designed in phases,including resistance,balance,and aerobic training.The Harris hip score(HHS),Tilburg frailty indicator(TFI),falls efficacy scale-international(FES-I),and Chinese version of the short form-36 health survey(SF-36)scores were compared among the four groups preoperatively,at 1 month,3 months postoperatively,and at the last follow-up.Results:A total of 124 elderly patients were involved,including 50 males and 74 females,aged 60-80 years[(71.8±5.0)years].All the patients were followed up for 6 months.The results of generalized estimating equation showed that the HHS,TFI,FES-I,and SF-36 scores differed significantly in terms of group effect,time effect,and interaction effect among the four groups across all the time points(P<0.05).Simple effect analysis indicated no significant differences in preoperative HHS,TFI,FES-I,or SF-36 scores among the four groups(P>0.05).The HHS scores at 1 and 3 months postoperatively were(54.3±5.1)points and(65.7±6.3)points in the umbilical moxibustion group,(61.3±5.3)points and(74.5±6.8)points in the exercise group,and(66.5±5.2)points and(86.3±6.7)points in the combination group,which were all significantly higher than(50.2±4.5)points and(60.7±5.1)points in the conventional nursing group(P<0.05),with the combination group showing higher scores than the umbilical moxibustion group and exercise group(P<0.05).At the last follow-up,the HHS score was(77.3±6.0)points in the conventional nursing group and(77.0±5.9)points in the umbilical moxibustion group(P>0.05);the score was(83.8±4.7)points in the exercise group and(91.4±3.5)points in the combination group,which were significantly higher than that in the conventional nursing group(P<0.05),with the combination group showing higher score than those in the umbilical moxibustion group and exercise group(P<0.05).At 1 month,3 months postoperatively,and at the last follow-up,the TFI total scores were 5.0(3.0,7.0)points,3.0(1.0,5.0)points,and 3.0(0.0,4.0)points in the umbilical moxibustion group,4.0(1.0,6.0)points,2.0(0.0,5.0)points,and 2.0(0.0,3.0)points in the exercise group,and 2.0(0.0,5.0)points,1.0(0.0,2.0)points,and 0.0(0.0,1.0)points in the combination group,which were all significantly lower than those in the conventional nursing group[7.0(5.0,10.0)points,7.0(5.0,9.0)points,and 6.0(5.0,8.0)points,respectively](P<0.05),with the combination group showing lower scores than the umbilical moxibustion group and exercise group(P<0.05).The physical and social dimension scores of TFI at 1 month,3 months postoperatively,and at the last follow-up were significantly lower in the umbilical moxibustion group,exercise group,and combination group than those in the conventional nursing group(P<0.05),with the combination group showing the lower scores than those in the umbilical moxibustion group and exercise group(P<0.05).At 1 month postoperatively,no statistically significant difference was observed among the four groups in the psychological dimension scores of TFI(P>0.05).At 3 months postoperatively and at the last follow-up,the psychological dimension scores of TFI in the umbilical moxibustion group,exercise group,and combination group were all lower than those in the conventional nursing group(P<0.05),with the combination group showing the lower scores than those in the umbilical moxibustion group and exercise group(P<0.05).At 1 month,3 months postoperatively,and at the last follow-up,the FES-I scores were(45.3±4.3)points,(40.9±3.9)points,and(33.9±2.8)points,respectively in the umbilical moxibustion group,(38.7±3.8)points,(32.9±3.6)points,and(30.3±2.2)points,respectively in the exercise group,and(34.2±3.6)points,(30.2±2.6)points,and(27.9±1.3)points,respectively in the combination group,which were all significantly lower than those in the conventional nursing group[(50.9±4.9)points,(50.0±4.9)points,and(40.7±4.2)points](P<0.05),with the combination group showing lower scores than those in the umbilical moxibustion group and exercise group(P<0.05).At 1 month,3 months postoperatively,and at the last follow-up,the SF-36 physical health scores were(60.6±3.7)points,(76.1±3.5)points,and(78.4±2.6)points,respectively in the umbilical moxibustion group,(57.6±3.7)points,(78.4±3.7)points,and(80.4±3.1)points,respectively in the exercise group,and(65.7±3.1)points,(85.9±2.9)points,and(87.4±2.2)points,respectively in the combination group,which were all significantly higher than those in the conventional nursing group[(47.5±4.6)points,(65.9±4.6)points,and(68.3±4.4)points](P<0.05),with the combination group showing higher scores than those in the umbilical moxibustion group and exercise group(P<0.05).At 1 month,3 months postoperatively,and at the last follow-up,the SF-36 mental health scores were(59.7±4.1)points,(74.5±3.6)points,and(76.2±3.0)points,respectively in the umbilical moxibustion group,(59.4±4.6)points,(74.1±3.8)points,and(74.4±3.9)points,respectively in the exercise group,and(66.9±4.1)points,(81.6±3.3)points,and(79.9±3.7)points,respectively in the combination group,which were all significantly higher than those in the conventional nursing group[(52.8±5.2)points,(64.0±4.9)points,and(65.3±5.1)points](P<0.05),with the combination group showing higher scores than those in the umbilical moxibustion group and exercise group(P<0.05).Conclusion:For elderly patients with intertrochanteric femoral fracture combined with frailty,umbilical moxibustion combined with a multi-component exercise program can significantly improve hip function,reduce frailty and fall risk,and enhance quality of life.
作者
李潆
魏岚
赵宁
陈丽丽
张静
Li Ying;Wei Lan;Zhao Ning;Chen Lili;Zhang Jing(Department of Nursing,Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China;First Department of Neck,Shoulder,Lower Back and Leg Pain,Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China)
出处
《中华创伤杂志》
北大核心
2025年第10期998-1007,共10页
Chinese Journal of Trauma
基金
河南省中医药科学研究专项课题(2024ZY2166)
豫卫中医药科教([2024]4号)。
关键词
股骨骨折
灸法
运动疗法
康复护理
衰弱
Femoral fractures
Moxibustion
Exercise therapy
Rehabilitation nursing
Frailty
