Rehabilitation nursing in patients undergoing elbow arthroscopic arthrolysis
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摘要:目的
探讨康复护理模式在肘关节镜下关节松解术患者中的应用效果。
方法选取86例行康复护理的肘关节镜下关节松解术患者，于术后24、48、72 h和4、7 d评估患肢肿胀程度、疼痛程度，于术前1 d、术后2个月记录患者的肘关节功能及活动范围。分析患者肘关节活动度与临床资料的相关性。
结果患者术后肘横纹围度、肘横纹上5 cm、肘横纹下5 cm以及视觉模拟评分法(VAS)评分呈时间依赖性降低，差异有统计学意义(P < 0.01)。术后2个月，患者屈曲活动度大于术前，伸直活动度小于术前，差异有统计学意义(P < 0.01)。患者术后2个月的屈曲活动度与术前伸直活动度呈负相关(P < 0.01), 与术前屈曲活动度呈正相关(P < 0.01)。无外伤史、有高血压、有糖尿病患者术后肘关节活动度恢复程度差于有外伤史、无高血压、无糖尿病患者，差异有统计学意义(P < 0.05)。
结论康复护理模式可缓解肘关节镜下关节松解术后患者的疼痛、肿胀程度。术前活动度差、无外伤史、高血压及糖尿病患者术后肘关节活动度恢复差，康复护理时应予以重视。
Abstract:ObjectiveTo explore the effect of rehabilitation nursing mode in patients undergoing elbow arthroscopic arthrolysis.
MethodsA total of 86 patients with elbow arthroscopic arthrolysis were selected for rehabilitation nursing. The degree of swelling and pain were evaluated at 24, 48, 72 hours and 4, 7 days postoperatively and elbow function and range of motion were recorded 1 day before surgery and 2 months after surgery. The correlation between elbow range of motion and clinical data was analyzed.
ResultsPostoperative cubital crease circumference, 5 cm above as well as 5 cm below the cubital crease and Visual Analogue Scale (VAS) score decreased in a time-dependent manner (P < 0.01). Two months after surgery, the range of flexion activity was significantly higher than that before surgery, and the range of extension activity was significantly lower than that before surgery (P < 0.01). The range of flexion activity two months after surgery was negatively correlated with the preoperative range of extension activity (P < 0.01), and was positively correlated with the preoperative range of flexion activity (P < 0.01). Postoperative elbow range of motion in patients with no history of trauma, with hypertension and diabetes was significantly worse than that in patients with history of trauma and those without hypertension and diabetes (P < 0.05).
ConclusionRehabilitation nursing mode can relieve the pain and swelling degree of patients undergoing elbow arthroscopic arthrolysis. Poor preoperative range of motion, no history of trauma, hypertension and diabetes patients have poor postoperative elbow range of motion recovery, thus rehabilitation nursing should be paid attention to them.
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表 1 患者患肢肿胀度及疼痛评分比较(x±s)
时点 肿胀程度/cm 视觉模拟评分法评分/分 肘横纹围度 肘横纹上5 cm围度 肘横纹下5 cm围度 术后24 h 27.57±1.73 27.00±1.74 26.37±1.40 3.07±0.59 术后48 h 27.03±1.65 26.30±1.68 25.53±1.45** 2.13±0.52** 术后72 h 26.73±1.75**## 25.67±1.53**## 24.57±1.55** 1.60±0.74** 术后4 d 26.10±1.82**## 25.40±1.83**## 24.40±1.66** 1.20±0.68** 术后7 d 24.40±1.73**## 23.67±1.70**## 22.57±1.49** 0.67±0.62** 与术后24 h比较, **P < 0.01; 与术后48 h比较, ## P < 0.01。 
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表 2 患者术前信息与术后屈曲恢复的分析(x±s)
术前变量 术后屈曲度/° t P 性别 男 96.14±10.17 -0.11 0.07 女 96.43±13.40 外伤 有 99.44±9.37 -1.28 0.02 无 95.44±12.27 高血压 有 77.33±7.98 10.18 < 0.01 无 100.28±7.92 糖尿病 有 74.17±5.14 10.71 < 0.01 无 99.86±8.02
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表 3 患者术前信息与术后伸直恢复的分析(x±s)
术前变量 术后伸直度/° t P 性别 男 6.93±3.61 0.18 0.62 女 6.79±3.79 外伤 有 5.83±1.92 1.33 < 0.01 无 7.13±3.98 高血压 有 12.00±4.92 -7.74 < 0.01 无 5.77±2.18 糖尿病 有 13.75±4.33 -10.65 < 0.01 无 5.74±1.97
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[1] ZHANG D F, NAZARIAN A, RODRIGUEZ E K. Post-traumatic elbow stiffness: Pathogenesis and current treatments[J]. Shoulder Elbow, 2020, 12(1): 38-45. doi: 10.1177/1758573218793903
[2] DAI J X, ZHANG G F, LI S L, et al. Arthroscopic treatment of posttraumatic elbow stiffness due to soft tissue problems[J]. Orthop Surg, 2020, 12(5): 1464-1470. doi: 10.1111/os.12787
[3] XIONG H, SUN Z Y, CHEN S, et al. Effect of hyperuricemia on functional outcomes and complications in patients with elbow stiffness after open arthrolysis combined with hinged external fixation: a retrospective study[J]. J Shoulder Elbow Surg, 2020, 29(7): 1387-1393. doi: 10.1016/j.jse.2020.02.021
[4] 张素萍. 肘关节镜下治疗骨关节炎患者的康复护理[J]. 中国医药指南, 2014, 12(16): 353-354. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK201416267.htm [5] 王怡, 关文也, 周正宏. 肘关节镜下松解治疗创伤后肘关节僵硬的康复与护理[J]. 护理研究, 2013, 27(35): 4045-4046. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201335042.htm [6] 朱琳怡, 毛雷音, 徐颢庭, 等. 关节镜下肘关节松解术后行CPM同步局部冰敷效果分析[J]. 中国医药科学, 2020, 10(15): 226-229, 243. doi: 10.3969/j.issn.2095-0616.2020.15.062 [7] SUN Z Y, LI J H, LUO G, et al. What constitutes a clinically important change in Mayo Elbow Performance Index and range of movement after open elbow arthrolysis[J]. Bone Joint J, 2021, 103-B(2): 366-372. doi: 10.1302/0301-620X.103B2.BJJ-2020-0259.R3
[8] DE KLERK H H, WELSINK C L, SPAANS A J, et al. Arthroscopic and open debridement in primary elbow osteoarthritis: a systematic review and meta-analysis[J]. EFORT Open Rev, 2020, 5(12): 874-882. doi: 10.1302/2058-5241.5.190095
[9] ENG H C, RIAZI S, VEILLETTE C, et al. An expedited care pathway with ambulatory brachial plexus analgesia is a cost-effective alternative to standard inpatient care after complex arthroscopic elbow surgery: a randomized, single-blinded study[J]. Anesthesiology, 2015, 123(6): 1256-1266. doi: 10.1097/ALN.0000000000000852
[10] HE X, FEN Q, YANG J R, et al. Risk factors of elbow stiffness after open reduction and internal fixation of the terrible triad of the elbow joint[J]. Orthop Surg, 2021, 13(2): 530-536. doi: 10.1111/os.12879
[11] QIAN Y, YU S Y, SHI Y, et al. Risk factors for the occurrence and progression of posttraumatic elbow stiffness: a case-control study of 688 cases[J]. Front Med (Lausanne), 2020, 7: 604056.
[12] ZHENG W, LIU J Z, SONG J L, et al. Risk factors for development of severe post-traumatic elbow stiffness[J]. Int Orthop, 2018, 42(3): 595-600. doi: 10.1007/s00264-017-3657-1
[13] GIANNICOLA G, BULLITTA G, POLIMANTI D, et al. Factors affecting choice of open surgical techniques in elbow stiffness[J]. Musculoskelet Surg, 2014, 98(Suppl 1): 77-85.
[14] YANG Y P, YUAN S, LI N, et al. Analysis of factors influencing the efficacy of extracapsular arthroscopic surgery for refractory tennis elbow[J]. Zhonghua Wai Ke Za Zhi, 2019, 57(11): 818-823.
[15] CARLIER Y, LENOIR H, ROULEAU D M, et al. Arthroscopic debridement for osteoarthritis of the elbow: results and analysis of predictive factors[J]. OrthopTraumatol Surg Res, 2019, 105(8S): S221-S227. http://www.sciencedirect.com/science/article/pii/S1877056819302580
[16] PARK I, OH M J, SHIN S J. Minimal clinically important differences and correlating factors for the Rowe score and the American shoulder and elbow surgeons score after arthroscopic stabilization surgery for anterior shoulder instability[J]. Arthroscopy, 2019, 35(1): 54-59. doi: 10.1016/j.arthro.2018.08.005
[17] JHAN S W, CHOU W Y, WU K T, et al. Outcomes and factors of elbow arthroscopy upon returning to sports for throwing Athletes with osteoarthritis[J]. J Orthop Surg Res, 2018, 13(1): 280. doi: 10.1186/s13018-018-0992-x
[18] NOTICEWALA M S, TROFA D P, VANCE D D, et al. Elbow arthroscopy: 30-day postoperative complication profile and associated risk factors[J]. Arthroscopy, 2018, 34(2): 414-420. doi: 10.1016/j.arthro.2017.08.286
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