基于格林模式的分阶段康复护理在不稳定骨盆骨折患者中的应用效果

叶杨; 陈和珍; 王谊; 王鉴顺

doi:10.16766/j.cnki.issn.1674-4152.003899

基于格林模式的分阶段康复护理在不稳定骨盆骨折患者中的应用效果

doi: 10.16766/j.cnki.issn.1674-4152.003899

温州医科大学附属第二医院骨科，浙江温州 325027

基金项目:

浙江省医药卫生健康科技计划项目 2022KY209

温州市基础性公益科研项目 Y20220532

详细信息

通讯作者:
王谊，E-mail：wy125454@163.com

中图分类号: R683.3 R473.6
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- 文章访问数: 9
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- 被引次数: 0
出版历程
- 收稿日期: 2024-07-10
- 网络出版日期: 2025-03-27

Study on the effect of phased rehabilitation care based on the Green model in patients with unstable pelvic fractures

Orthopedics Department, the 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China

摘要

摘要: 目的探讨基于格林模式的分阶段康复护理在不稳定骨盆骨折患者中的应用效果，以期能改善骨盆骨折患者的康复效果。方法以2021年7月—2022年7月于温州医科大学附属第二医院创伤骨科住院治疗的62例不稳定骨盆骨折患者作为对照组，以2022年10月—2023年12月住院治疗的71例不稳定骨盆骨折患者作为观察组。对照组实施常规康复指导，观察组采用基于格林模式的分阶段康复护理。比较2组患者的术后首次下床活动时间、住院时间、住院期间的下肢深静脉血栓发生率、日常生活活动能力和骨盆功能恢复状况。结果观察组的术后首次下床活动时间和住院时间均明显少于对照组(P < 0.01)。住院期间对照组下肢深静脉血栓发生率为6/62(9.7%)，观察组为1/71(1.4%)，差异有统计学意义(χ²=4.539，P=0.033)。出院前2组日常生活活动能力和骨盆功能状况差异无统计学意义(P>0.05)，术后3个月及术后6个月观察组的日常生活活动能力和骨盆功能恢复状况均明显高于对照组(P < 0.05)。结论基于格林模式的分阶段康复护理可缩短骨盆骨折患者首次下床活动时间和住院时间，降低患者深静脉血栓发生率，提升患者日常生活活动能力，改善患者骨盆恢复状况，值得临床推广与应用。
- 骨盆骨折 /
- 格林模式 /
- 分阶段康复护理
Abstract: Objective To explore the application effect of the phased rehabilitation care based on the Green model, and improve the rehabilitation effect of patients with unstable pelvic fractures. Methods A total of 62 patients with unstable pelvic fractures hospitalized in the Orthopedic Trauma Department of the 2nd Affiliated Hospital of Wenzhou Medical University hospital from July 2021 to July 2022 were collected as the control group, and 71 patients hospitalized from October 2022 to December 2023 were taken as the observation group. The control group implemented routine rehabilitation guidance, and the observation group adopted phased rehabilitation care based on the Green model. The time of first ambulation, hospital stay, incidence of lower extremity deep vein thrombosis during hospitalization, activities of daily living, and recovery of pelvic function were compared between the two groups. Results The first postoperative ambulation time and hospitalization time in the observation group were significantly less than those in the control group (P < 0.01). The incidence of deep vein thrombosis was 6/62 (9.7%) in the control group and 1/71 (1.4%) in the observation group, which was significant (χ²=4.539, P=0.033). There was no significant difference in the activities of daily living, and pelvic function of the two groups before discharge (P>0.05), and both in the observation group were significantly higher than that of the control group in 3 months and 6 months after surgery (P < 0.05). Conclusion The phased rehabilitation care based on the Green model can shorten the first ambulation time and hospitalization time, reduce the incidence of deep vein thrombosis, and improve the ability of daily living activities and the recovery status, which is worthy of clinical promotion and application.
- Unstable pelvic fractures /
- Green model /
- Phased rehabilitation care

HTML全文

表 1 2组不稳定骨盆骨折患者术后首次下床活动时间和住院时间比较(x±s，d)

Table 1. Comparison of the time to first ambulation and length of hospital stay between two groups of patients with unstable pelvic fractures after surgery.(x±s, d)

组别	例数	术后首次下床活动时间	住院时间
对照组	62	7.87±1.84	14.21±3.52
观察组	71	5.94±1.63	12.24±3.04
t值		-6.362	-3.429
P值		< 0.001	0.001

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表 2 2组不稳定骨盆骨折患者出院前下肢深静脉血栓发生率比较[例(%)]

Table 2. Comparison of the incidence of lower extremity deep venous thrombosis before discharge between two groups of patients with unstable pelvic fracture[cases (%)]

组别	例数	下肢深静脉血栓
组别	例数	是	否
对照组	62	6(9.7)	56(90.3)
观察组	71	1(1.4)	70(98.6)
χ²值		4.539
P值		0.033

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表 3 2组的不稳定骨盆骨折患者各时点日常生活活动能力比较(x±s，分)

Table 3. Comparison of daily living activities ability at various time points between the two groups of patients with unstable pelvic fractures(x±s, points)

组别	例数	出院前	术后3个月	术后6个月
对照组	62	39.16±6.27	60.33±8.11	77.54±10.73
观察组	71	40.24±7.12	65.24±8.57	85.41±11.28
F值		0.851	11.418	16.859
P值		0.358	0.001	< 0.001
注：F_时间=65.118，P < 0.001; F_组间=13.456, P < 0.001; F_交互=4.921, P=0.008。

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表 4 2组不稳定骨盆骨折患者各时点骨盆功能恢复状况比较(x±s，分)

Table 4. Comparison of pelvic function recovery status at various time points between two groups of patients with unstable pelvic fractures.(x±s, points)

组别	例数	出院前	术后3个月	术后6个月
对照组	62	49.42±7.11	60.16±8.86	76.31±10.34
观察组	71	51.03±7.36	67.33±9.10	80.12±10.92
F值		1.635	21.056	4.233
P值		0.203	< 0.001	0.042
注：F_时间=43.246，P < 0.001; F_组间=11.981，P < 0.001; F_交互=5.113，P=0.007。

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参考文献(16)

[1]	崔鹏举. 双平面定位方法引导骶髂螺钉置入治疗骨盆不稳定骨折[D]. 济南: 山东大学, 2023. CUI P J. A biplanar positioning method to guide ilioscacral screw insertion for the treatment of unstable pelvic fractures[D]. Jinan: Shandong University, 2023.
[2]	刘涛, 孙海钰. 骨盆骨折诊疗进展[J]. 国际骨科学杂志, 2024, 45(1): 27-32. LIU T, SUN H Y. Progress in the diagnosis and treatment of pelvic fractures[J]. International Journal of Orthopaedics, 2024, 45(1): 27-32.
[3]	李想, 黄晨, 谢美明, 等. 骨盆骨折手术治疗进展[J]. 国际骨科学杂志, 2024, 45(3): 183-186. LI X, HUANG C, XIE M M, et al. Progress in the surgical treatment of pelvic fractures[J]. International Journal of Orthopaedics, 2024, 45(3): 183-186.
[4]	中国康复医学会骨与关节分会创伤骨科学组, 王金辉, 葛宇峰, 等. 骨科康复一体化模式下骨盆骨折围手术期康复治疗技术规范专家共识[J]. 中华创伤骨科杂志, 2021, 23(10): 829-836. Trauma and Bone Science Group, Bone and Joint Branch, Chinese Rehabilitation Medical Association, WANG J H, GE Y F, et al. Expert consensus on specifications for perioperative rehabilitation after pelvic fractures in light of integration of orthopedics and rehabilitation[J]. Chinese Journal of Orthopaedic Trauma, 2021, 23(10): 829-836.
[5]	游海玲. 基于格林模式的糖尿病视网膜病变患者健康教育方案的构建及应用研究[D]. 重庆: 重庆医科大学, 2023. YOU H L. Construction and applications study of health education program based on precede-proceed model for diabetic retinopathy patients[D]. Chongqing: Chongqing Medical University, 2023.
[6]	姜寒嫣, 吴可人. 基于格林模式的团队合作护理在胆囊手术中的应用效果[J]. 中华全科医学, 2024, 22(5): 887-891. doi: 10.16766/j.cnki.issn.1674-4152.003527 JIANG H Y, WU K R. Effect of teamwork nursing based on the Green model in gallbladder surgery[J]. Chinese Journal of General Practice, 2024, 22(5): 887-891. doi: 10.16766/j.cnki.issn.1674-4152.003527
[7]	谢瑶, 李涓玉, 王习竹, 等. 格林模式在慢性病健康管理中的应用进展[J]. 职业与健康, 2024, 40(2): 279-283. XIE Y, LI J Y, WANG X Z, et al. Application progress of PRECEDE-PROCEED model in health management of chronic disease[J]. Occupation and Health, 2024, 40(2): 279-283.
[8]	黄瑞芳. 微信平台联合格林模式行连续康复护理对髋部骨折患者关节功能及生活自理能力的影响[J]. 医疗装备, 2023, 36(18): 158-161. HUANG R F. The effect of continuous rehabilitation nursing on the joint function of patients with hip fracture through Wechat platform and Green Mode[J]. Medical Equipment, 2023, 36(18): 158-161.
[9]	江利冰, 蒋守银, 赵小纲, 等. 世界急诊外科学会骨盆骨折分型及处理指南[J]. 中华急诊医学杂志, 2017, 26(3): 268-269. JIANG L B, JIANG S Y, ZHAO X G, et al. Guidelines for the classification and the management of pelvic fractures of the World Society of Emergency Surgery[J]. Chinese Journal of Emergency Medicine, 2017, 26(3): 268-269.
[10]	赵清斌, 李祖涛, 殷剑, 等. 腰髂固定联合经皮骨盆前环固定治疗垂直旋转不稳定型骨盆环骨折[J]. 生物骨科材料与临床研究, 2023, 20(6): 52-55. ZHAO Q B, LI Z T, YIN J, et al. Treatment of unstable pelvic ring injury by posterior lumbo-iliac fixation combined with minimally invasive percutaneous anterior pelvic ring internal fixation[J]. Orthopaedic Biomechanics Materials and Clinical Study, 2023, 20(6): 52-55.
[11]	徐练, 林旭, 吴超, 等. 两种内固定治疗骨盆前环骨折的疗效比较[J]. 临床骨科杂志, 2024, 27(3): 390-394. XU L, LIN X, WU C, et al. Comparison efficacy of two kinds of internal fixation for pelvic anterior ring fractures[J]. Journal of Clinical Orthopaedics, 2024, 27(3): 390-394.
[12]	杨艳霞, 宋琼, 周洁, 等. 格林模式联合自动化腹膜透析在容量超负荷腹膜透析患者中的应用[J]. 齐鲁护理杂志, 2024, 30(6): 141-144. YANG Y X, SONG Q, ZHOU J, et al. Application of Green mode combined with automated peritoneal dialysis in patients with volume overload peritoneal dialysis[J]. Journal of Qilu Nursing, 2024, 30(6): 141-144.
[13]	肖黎, 王辉, 汪雷, 等. 多元合作术后加速康复护理干预在骨盆骨折行骶髂固定患者围术期中的应用[J]. 现代医学, 2020, 48(3): 408-412. XIAO L, WANG H, WANG L, et al. Multivariate ERAS nursing intervention for patients with Tile C pelvic fractures undergoing Legency cMAS sacroiliac fixation[J]. Modern Medical Journal, 2020, 48(3): 408-412.
[14]	葛小艳. 基于加速康复外科理念的护理方案在骨盆骨折围术期中的应用[J]. 河北北方学院学报(自然科学版), 2023, 39(10): 15-17. GE X Y. Application of nursing programs based on the concept of accelerated rehabilitation surgery in the perioperative period of pelvic fracture[J]. Journal of Hebei North University(Natural Science Edition), 2023, 39(10): 15-17.
张凡, 李伦兰, 戴晴, 等. 加速康复护理清单在胸腰椎骨折患者围手术期的应用效果[J]. 安徽医学, 2020, 41(7): 846-849. LI Y W. Effect of pain control care in patients with traumatic fractures and its impact on postoperative rehabilitation[J]. Journal of Anhui Medicine, 2020, 41(7): 846-849.
[16]	王宁霞, 寄婧, 李超. 基于快速康复外科理念的功能康复对Tile C型骨盆骨折患者的影响[J]. 甘肃医药, 2023, 42(12): 1129-1131. WANG N X, JI J, LI C. The impact of functional rehabilitation based on the surgical concept of rapid rehabilitation on patients with Tile C pelvic fractures[J]. Gansu Medical Journal, 2023, 42(12): 1129-1131.