Practice and effect of postoperative transitional care of pediatric supracondylar humerus fracture under orthopedic rehabilitation nursing clinic
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摘要:
目的 探讨基于骨科康复门诊的延续护理模式对儿童肱骨髁上骨折康复的干预效果。 方法 选取2020年7—10月安徽省儿童医院儿童骨科采用闭合复位克氏针内固定术治疗肱骨髁上骨折(Gartland Ⅱ型、Ⅲ型)的86例患儿，采用随机数字表法分为对照组(40例)和观察组(46例)。对照组给予功能锻炼视频指导联合微信平台跟踪的延续护理方法，观察组在对照组的基础上加以专科护士和康复治疗师主导的骨科康复护理门诊管理模式。比较2组患儿术后6个月康复锻炼的依从性、患儿家长满意度、肘关节功能评分(MEPS)、肘关节运动范围评分(ROM)。 结果 观察组与对照组康复锻炼依从性评分为(83.20±13.82)分和(71.00±16.49)分(P＜0.001)；家长满意度评分为(77.17±20.97)分和(66.25±21.60)分(P=0.020)；肘关节MEPS评分为(88.04±8.33)分和(82.50±7.33)分(P=0.002)，差异均有统计学意义；肘关节ROM评分在屈曲、伸直、旋前、旋后4个角度评价中观察组均高于对照组(均P＜0.05)。 结论 基于骨科康复护理门诊的延续护理管理模式可以促进儿童肱骨髁上骨折术后肘关节功能的康复，提高功能锻炼依从性和患儿家长满意度。 Abstract:Objective To evaluate the intervention effect of transitional care upon orthopedic rehabilitation clinic on the rehabilitation of pediatric supracondylar humerus fracture. Methods Between July 2020 and October 2020, 86 cases of pediatric Supracondylar humerus fractures (Gartland Ⅱ/Ⅲ) were selected in Anhui Provincial Children's Hospital from patients who underwent surgery with operated in closed reduction and percutaneous pinning, they were divided into control group (n=40) and observation group (n=46) by using random number table. All the candidates were received the transitional care characterized by video guided functional exercise that combined with Wechat platform tracking, besides, the patients in observation group were under the management of orthopedic nursing rehabilitation clinic with rehabilitation specialist and orthopedic specialist nurse. The compliance of rehabilitation exercise, the satisfaction of the parents, the MEPS (Mayo elbow performance score), and the score of ROM (range of motion) were compared between the two groups. Results When comparing between the observation group and the control group, the score of compliance of rehabilitation exercise were (83.20±13.82) points and (71.00±16.49) points, respectively (P < 0.001), the score of parents'satisfaction were (77.17±20.97) points and (66.25±21.60) points, respectively (P=0.020), and the MEPS were (88.04±8.33) points and (82.50±7.33) points, respectively (P=0.002), the referred indicators between the two groups had statistical difference. The ROM scores associated with flexion, extension, pronation and supination of elbow function in the observation group were higher than that of the control group (all P < 0.05). Conclusion The transitional care in orthopedic rehabilitation clinic can promote the postoperative rehabilitation of elbow joint of pediatric supracondylar humerus fracture, which improving the rehabilitation training compliance and increasing the satisfaction of the parents. -
图 1 MEPS评分中运动功能检查
注：A为评分量表细则；B为肘关节屈曲功能较对侧正常肘比较；C为肘关节伸直功能较对侧正常肘比较；D为检查有无肘内翻、肘外翻肘关节不稳定。
Figure 1. Motor function examination in MEPS score
图 2 肘关节ROM评分角度测量
注：A为肘关节屈曲；B为肘关节伸直；C为肘关节内旋；D为肘关节外旋。
Figure 2. ROM score and angle measurement of elbow joint
表 1 2组肱骨髁上骨折患儿临床资料比较
Table 1. Comparison of clinical data between two groups of children with supracondylar humerus fracture
组别 例数 性别(例) 侧别(例) 年龄(x±s, 岁) BMI(x±s) 手术时间(x±s, min) 术后住院时间(x±s, d) 男 女 左 右 观察组 46 25 21 27 19 4.21±2.17 16.15±2.91 28.37±19.63 2.33±0.89 对照组 40 23 17 23 17 4.23±2.31 16.16±2.13 28.65±18.87 2.44±0.98 统计量 0.086a 0.013a -0.048b -0.006b -0.067b -0.574b P值 0.769 0.911 0.962 0.995 0.947 0.576 
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表 2 2组肱骨髁上骨折患儿术后肘关节功能比较(x ±s)
Table 2. Comparison of elbow joint function between two groups of children with supracondylar humerus fracture
组别 例数 肘关节ROM评分(°) MEPS评分(分) 屈曲 伸直 旋前 旋后 疼痛 日常活动 运动功能 关节稳定 总分 观察组 46 132.93±11.08 5.00±3.50 82.39±10.79 81.96±10.67 41.41±7.20 21.09±4.34 16.63±2.99 8.91±2.09 88.04±8.33 对照组 40 126.75±14.53 2.50±3.20 74.50±11.31 76.50±11.67 37.88±8.98 18.38±3.99 16.88±3.70 9.38±1.68 82.50±7.33 t值 2.194 3.439 3.308 2.265 2.027 3.020 -0.339 -1.121 3.251 P值 0.031 0.001 0.001 0.026 0.046 0.003 0.736 0.265 0.002
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表 3 2组肱骨髁上骨折患儿依从性及家长满意度情况比较(x ±s, 分)
Table 3. Comparison of compliance and parental satisfaction between two groups of children with supracondylar humerus fracture
组别 例数 依从性得分 满意度得分 观察组 46 83.20±13.82 77.17±20.97 对照组 40 71.00±16.49 66.25±21.60 t值 3.950 2.377 P值 <0.001 0.020
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