目的:探讨基于Roy适应模式(RAM)的协同护理对术后功能重建的影响。股骨粗隆间骨折患者的软组织疼痛和生活质量。
方法:本研究采用回顾性配对对照方法。选择2018年7月至2021年9月我院收治的96例股骨粗隆间骨折患者。根据不同的护理方法,将患者分为协作组和常规组,每组48例。两组患者均采用髓内钉手术治疗。常规组给予常规围手术期护理干预,协作组在此基础上给予协同护理干预。比较两组干预前后髋关节功能恢复情况及生活质量。术前、术后疼痛程度,记录两组围手术期并发症。采用Logistic多因素回归分析影响股骨粗隆间骨折患者术后髋关节功能恢复的危险因素,从而构建风险预测模型。采用ROC曲线分析影响因素预测股骨粗隆间骨折患者术后髋关节功能恢复的临床价值。
结果:合作组干预后Harris各维度评分明显高于干预前及常规组(P<0.05)。干预后,协作组髋关节功能优良率为83.33%,显著高于常规组的60.42%(P<0.05)。术后各时间点协同组VAS评分明显低于常规组(P<0.05)。干预后,生理功能的分数,生理作用,协作组的身体疼痛和一般健康状况明显高于常规组(P<0.05)。协作组并发症发生率为6.25%,显著低于常规组的22.92%(P<0.05)。年龄差异有统计学意义,术前ASA分级,内固定方法,髋关节恢复优组与髋关节恢复差组的骨质疏松分级及围手术期护理方法差异有统计学意义(P<0.05)。Logistic多因素回归分析显示,年龄,术前ASA分级,内固定方式和骨质疏松分级是影响术后髋关节功能恢复的危险因素,围手术期护理方法是保护因素(P<0.05)。影响因素中,内固定方式及骨质疏松程度对预测股骨粗隆间骨折患者术后髋关节功能恢复有一定的临床价值。
结论:基于RAM模式的协同护理方法可有效恢复股骨粗隆间骨折患者术后髋关节功能。减轻患者围手术期疼痛程度,提高患者的生活质量,降低并发症的发生率,可在临床上推广应用。此外,影响股骨粗隆间骨折患者术后髋关节功能恢复的因素很多,根据影响因素采取有针对性的措施提高髓内钉治疗效果。
OBJECTIVE: To explore the effect of collaborative nursing based on Roy Adaptive Mode (RAM) on postoperative functional reconstruction, soft tissue pain and quality of life in patients with femoral intertrochanteric fracture.
METHODS: A retrospective matched control method was used in this study. A total of 96 patients with femoral intertrochanteric fracture admitted to our hospital from July 2018 to September 2021 were selected. According to different nursing methods, the patients were divided into a collaborative group and a routine group, with 48 cases in each group. Patients in both groups were treated with intramedullary nail surgery. The routine group was given routine perioperative nursing intervention, and the collaborative group was given collaborative nursing intervention on this basis. The hip function recovery and quality of life before and after the intervention were compared between the two groups. The preoperative and postoperative pain degree, and the perioperative complications of the two groups were recorded. Logistic multivariate regression analysis was used to analyze the risk factors affecting the recovery of hip joint function in patients with femoral intertrochanteric fracture after operation, thereby constructing a risk prediction model. ROC curve was used to analyze the clinical value of influencing factors in predicting postoperative hip function recovery in patients with femoral intertrochanteric fracture.
RESULTS: Harris score each dimension after intervention in the collaborative group was obviously higher than that of before intervention and the conventional group (P < 0.05). After intervention, the excellent and good rate of hip joint function the collaborative group was 83.33%, which was significantly higher than 60.42% in the routine group (P < 0.05). Postoperative VAS scores each time point in the collaborative group was obviously lower than that in the routine group (P < 0.05). After intervention, the scores of physiological function, physiological role, body pain and general health in the collaborative group were significantly higher than those in the routine group (P < 0.05). The incidence of complications in the collaborative group was 6.25%, which was significantly lower than 22.92% in the routine group (P < 0.05). There were statistically significant differences in age, preoperative ASA grade, internal fixation method, osteoporosis grade and perioperative nursing methods between the excellent hip recovery group and the poor hip recovery group (P < 0.05). Logistic multivariate regression analysis showed that age, preoperative ASA grade, internal fixation method and osteoporosis grade were the risk factors affecting the recovery of hip joint function after operation, and perioperative nursing method was the protective factor (P < 0.05). Among the influencing factors, the internal fixation method and the grade of osteoporosis had certain clinical value in predicting the recovery of hip joint function in patients with femoral intertrochanteric fracture after operation.
CONCLUSIONS: The RAM model-based collaborative nursing method may effectively restore the hip joint function of patients with femoral intertrochanteric fracture after operation, and may reduce the perioperative pain degree of patients, improve the quality of life of patients and reduce the incidence of complications, which can be popularized and applied in clinical practice. In addition, there are many factors influencing the recovery of hip joint function in patients with femoral intertrochanteric fracture after operation, and targeted measures should be taken according to the influencing factors to improve the effect of intramedullary nail treatment.