Physiother :在桡骨远端骨折的非手术石膏固定后,在建议下运动和增加活动,可促进疼痛范围和功能的改善。

2021-09-10 从医路漫漫 MedSci原创

探究在常规护理的基础上增加运动活动(MWM)是否能改善桡骨远端骨折固定后的预后。

目的:探究在常规护理的基础上增加运动活动(MWM)是否能改善桡骨远端骨折固定后的预后

方法:进行一项前瞻性、多中心、随机的临床试验,采用随机分配、盲法和意向治疗分析。参与者:67名成年人(76%女性,平均年龄60岁),接受桡骨远端骨折后石膏治疗。干预措施为对照组接受锻炼和建议,实验组接受相同的锻炼和建议,外加旋后和伸腕MWM。主要结局是4周时前臂旋后(干预后立即)。次要结果包括手腕伸展、屈曲、旋前、握力、QuickDASH(快速手臂、肩部和手的功能障碍指数评分调研问卷)、腕关节患者自行评估量表(PRWE)和全球变化评级。随访时间分别为4周和12周,患者评分分别在26周和52周进行。

结果:与对照组相比,实验组在4周时旋后角增加12°(95%可信区间5~20),在12周时增大8°(95%可信区间1~15)。实验组术后4周的各种次要结局均好转:伸展(14°,95%CI 7~20)、屈曲(9°,95%CI 4~15)、QuickDASH(211,95%CI 218~23)和PRWE(213,95%CI 223~24)。在12周时,旋后、伸展、屈曲和QuickDASH的益处仍然明显。实验组更有可能将他们的全球变化评价改为“改善”(风险差异为22%,95%可信区间为5~39)。在第26周和52周的参与者评分中,没有任何明显的收益,也没有副作用。

图 旋后和伸展的活动;A,旋后时,受试者在尺骨上转动桡骨,然后在保持转动的同时,努力旋后前臂。B.伸展手腕,受试者将放松的指尖轻轻放在桌子上,

用健康的手将桡骨远端向小拇指转动。C.使用一根细带将腕骨近端向拇指方向转动。D.当转动保持在B或C的姿势时,受试者通过向前倾促进手腕伸展。

表1 4周和12周时组间平均值(SD)、组内平均(SD)差值以及组间平均(95% CI)差值

表2 每组参与者的数量(%)和4周和12周两组之间的风险差异(95% CI),用于二分类结果。

结论:对于桡骨远端骨折的非手术治疗,在运动和建议的基础上加用中西医结合能更快、更有效地改善患者的运动障碍。

原文出处

Reid SA,  Andersen JM,  Vicenzino B,Adding mobilisation with movement to exercise and advice hastens the improvement in range, pain and function after non-operative cast immobilisation for distal radius fracture: a multicentre, randomised trial.J Physiother 2020 Apr;66(2)

 

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