Objective To compare the early rehabilitation effects of total hip arthroplasty (THA) with direct anterior approach (DAA) versus posterior approach (PA). Methods A retrospective analysis was made in the data of 83 patients with unilateral osteonecrosis of the femoral head between March 2014 and May 2017. Forty-eight patients were treated with THA via PA (PA group) and 35 patients were treated with THA via DAA (DAA group). There was no significant difference in gender, age, body mass index, stage of osteonecrosis of the femoral head, and disease duration between 2 groups (P>0.05). The length of incision, operation time, total amount of bleeding, the time of first postoperative walking with crutch, the time of first postoperative walking without crutch, the Harris scores, and the visual analogue scale (VAS) scores of 2 group were recorded and compared. Results All incisions healed primarily and no infection, dislocation, or fracture occurred. All patients were followed up 30.2 months on average (range, 6-44 months). The numbness symptom caused by the lateral femoral cutaneous nerve injury occurred in 2 patients of DAA group and released after symptomatic treatment. The length of incision, total amount of bleeding, the time of first postoperative walking with crutch, and the time of first postoperative walking without crutch of DAA group were significantly superior to those of PA group (P<0.05). The Harris scores of DAA group were significantly higher than those of PA group at 2 weeks and 1 month after operation (P<0.05), while no significant difference was found between 2 groups before operation and at 3 months and 6 months after operation (P>0.05). The VAS scores of DAA group were significantly lower than those of PA group at 1 day, 4 days, 1 week, and 2 weeks after operation (P<0.05), while no significant difference was found between 2 groups before operation (P>0.05). Conclusion DAA is meaningful to enhanced recovery after THA. But it should be chosen carefully because of the disadvantages, such as long learning curve, limited indications, and requirements of specific instruments.
Objective To explore the effect of self-designed early rehabilitation procedure of frozen shoulder incorporating high-frequency ultrasound technology in the outpatient treatment of patients with early frozen shoulder. Methods One hundred and eighty-two consecutive patients who attended the outpatient clinic of the Department of Rehabilitation Medicine of the First Affiliated Hospital of Xinjiang Medical University and were diagnosed with frozen shoulder between January 2018 and May 2021 were selected and randomly divided into the trial group and the control group, with 91 patients in each group. Patients in the trial group received early rehabilitation procedures for frozen shoulder, and patients in the control group received conventional physiotherapy. The Visual Analogue Scale (VAS) (including VAS score for resting pain and VAS score for active motion), active range of motion of the shoulder joint (external rotation, forward flexion, and abduction), Shoulder Pain and Dysfunction Index (SPADI) (including pain subscale score, dysfunction subscale score, and total score) were compared between the two groups before treatment (Week 0) and 4 and 8 weeks after the start of treatment (Week 4 and 8). Results A total of 143 patients (74 in the trial group and 69 in the control group) completed the study. There was no significant difference in any assessment index between the two groups in Week 0 (P>0.05). The results of the within-group comparison after treatment showed that the VAS score for resting pain (F=44.359, P<0.001), VAS score for active motion (F=158.458, P<0.001), anterior shoulder flexion (F=123.334, P<0.001), abduction mobility (F=117.539, P<0.001), total SPADI score (F=133.814, P<0.001), SPADI pain subscale score (F=74.093, P<0.001), and SPADI dysfunction subscale score (F=145.336, P<0.001) in Week 4 and 8 were better than those in Week 0, and the assessments in Week 8 were better than those in Week 4 in each group (P<0.05); in the control group, there was no statistically significant difference in the external rotation mobility of the shoulder in Week 4 compared with that in Week 0 (P=0.599), and the external rotation in Week 8 improved significantly compared with that in Week 0 (P<0.001), whereas the external rotation of the shoulder in Week 4 and 8 in the trial group improved significantly compared with that in Week 0 (P<0.001). The results of the between-group comparison after treatment showed that the two groups had statistically significant differences in resting shoulder pain VAS score (F=93.712, P<0.001), active motion VAS score (F=103.565, P<0.001), external shoulder rotation (F=13.388, P<0.001), anterior shoulder flexion (F=66.375, P<0.001), abduction mobility (F=110.253, P<0.001), total SPADI score (F=7.917, P=0.006), and SPADI pain subscale score (F=39.091, P<0.001); the SPADI dysfunction subscale score was lower in the trial group than that in the control group in Week 4 (P=0.002), but by Week 8 there was no statistically significant difference between the two groups (P=0.352). Conclusion The early rehabilitation program for frozen shoulder incorporating high-frequency ultrasound technology is more effective than conventional physiotherapy in the intervention of patients with early frozen shoulder, and may provide a referenceable example for the combined application of high-frequency ultrasound technology and physiotherapy.
目的 观察对比卒中单元早期康复护理对卒中偏瘫患者肢体功能恢复的效果。 方法 将2011年6月－12月期间住院的脑卒中偏瘫患者88例，按照发病时间分为试验组和对照组，发病5 d以内急性期入院者为试验组，5 d以上入院的超过急性期者为对照组。在规范治疗基础上予以相同的康复护理干预，对其日常生活活动能力采用改良的Rakin量表MRS评分来进行功能评定。 结果 试验组和对照组生活能自理人数分别占25%、13.6%，能部分自理的人数分别占56.8%、40.9%，试验组肢体功能恢复明显高于对照组（P＜0.05）。 结论 卒中单元早期康复护理对脑卒中偏瘫患者肢体功能恢复有重要意义。
Objective To collect the clinical data of victims with traumatic brain injury (TBI) admitted in the West China Hospital of Sichuan University within 2 weeks after 4.20 Lushan earthquake, and to analyze their clinical characteristics and effects of early rehabilitation, so as to provide baseline data for rescue TBI victims with the early rehabilitation treatment during emergency medical rescue. Methods A total of 392 victims admitted in the hospital from April 20th, 2013 to May 3rd, 2013 were screened, of which the TBI victims were clinically assessed and treated with early rehabilitation. Then both the activities of daily living (ADL) and the Rancho Los Amigos Cognitive Recovery Scale (RLA) before and after the treatment were analyzed. The data were input by Excel software, and the statistical analysis was performed by SPSS softwar. Results A total of 51 TBI victims at age from 3 to 84 years old were included finally. The categories of TBI included subarachnoid hemorrhage (41.2%), intracranial hematoma (33.3%) and mixed type (33.3%), and the severity were associated with the type of TBI. The GCS score of cerebral concussion was higher (13.25 ± 0.62) while that of the diffuse axonal injury was lower (4.50 ± 0.71). All victims (100%) had limited ADL, 74.51% had cognitive dysfunction, 9.80% had speech disorder, and 7.84% had dysphagia. After the early rehabilitation treatment, both ADL (before treatment: 34.82 ± 58.29, after treatment: 69.63 ± 22.29) and RLA (pre-treatment: 4.16 ± 1.24, treatment: 7.20 ± 1.69) were obviously higher than those before treatment, with statistical differences (both P lt;0.05). Conclusion The TBI categories of Lushan earthquake victims are various and mixed, and the severity associated with the type of TBI. All TBI victims are accompanied with more clinical problems and functional limitation. Early rehabilitation treatment is safe and effective to improve ADL and RLA as well.
Within 4 weeks after Lushan earthquake, 400 person-times were rescued in the West China Hospital of Sichuan University. There were 325 hospitalized victims, 238 surgeries including 202 orthopedic surgeries, 28 critical victims, and 1 severe victim. In order to avoid and reduce the complications, minimize disability, and recover in the early stage, a set of early rehabilitation nursing process was established by the department of rehabilitation of the West China Hospital since the 28th hour after the earthquake: set up the emergency teams for early rehabilitation nursing, and clarify the responsibilities of each team; select the technicians of early rehabilitation nursing, and perform scientific management; build the information platform for early rehabilitation nursing, and make information unobstructed; strengthen the cooperation with professional and social organizations. This nursing mode helps the victims get rehabilitation care and treatment timely and efficiently. Up to the 4 weeks after earthquake, 178 person-times recover, accounted for 44.5%; and the records of 69 victims in Wenjiang branch of the hospital show zero death after orthopedic surgery.
Objective To explore the effect of early rehabilitation treatment on complications and prognosis of elderly patients with sever pneumonia undergoing mechanical ventilation. Methods The patients who meeting the inclusion criteria were randomly divided into an early rehabilitation group and a control group, with 35 cases in each group. On basis of same routine treatment, the early rehabilitation group was treated with early rehabilitation. The early rehabilitation methods included exercise therapy, electrical stimulation therapy, swallowing therapy, cough training and wheelchair-bed transfer training, etc. The patients received individual training methods according to their conditions. The difference of two groups were observed in the rates of ICU-acquired weakness (ICU-AW), ventilator-associate pneumonia (VAP), the incidence of delirium, the mechanical ventilation time, ICU-hospital time, total hospital time, 30-day hospital mortality, extubation fail rate and tracheotomy rate. Results Compare with the control group, the incidence of ICU-AW (14.28% vs. 37.14%), VAP (8.57% vs. 28.57%), and delirium (40.00% vs. 65.71%) in the early rehabilitation group were significantly reduced (all P<0.05). The duration of delirium [(3.50±1.31) dvs. (6.40±1.47) d], the ventilation time [(6.32±2.19) d vs. (9.40±4.43) d], ICU hospitalization time [(10.80±3.64) d vs. (15.31±3.85) d] and total hospitalization time [(22.52±7.56) d vs. (30.22±11.54) d] of the early rehabilitation group were significantly lower than the control group (all P<0.001). The tracheotomy rate and 30-day hospital mortality of the early rehabilitation group were significantly lower than the control group (25.71%vs. 51.42% and 28.57% vs. 54.28%, both P<0.05). There was no significant difference in extubation fail rate (5.71%vs. 11.42%, P>0.05). In the early rehabilitation group, there were no complications such as pipe prolapse, limb injury or serious arrhythmia. Conclusion Early rehabilitation can reduce the incidence of ICU-AW, VAP, delirium in elderly patients with severe pneumonia, help to shorten the mechanical ventilation time, ICU hospitalization time and total hospitalization time, reduce extubation failure rate and tracheotomy rate, so it is safe and effective, and worthy of being popularized and applied.
ObjectiveTo explore the effect of early rehabilitation nursing on elbow joint function recovery after artificial radial head replacement. MethodsFrom June 2010 to June 2012, 42 patients with artificial radial head replacement were randomly divided into two groups:trial group and control group. The control group was treated by the doctor instructions following routine rehabilitation therapy and nursing. The trial group received the guidance of professional rehabilitation nursing and early rehabilitation training. ResultsThe patients' range of elbow joint activities, alleviation of the pain, the strength grade, and the rehabilitation effect in the trial group was obviously better than those in the control group (P<0.05). There was no statistically significant difference between two groups in joint stability (P<0.05). ConclusionThe rehabilitation nursing should start early after the surgery for the artificial radial head replacement. It can prevent joint stiffness, joint conglutination and muscle disuse atrophy, reduce complications, and improve the quality of survival.
Objective To explore the common rehabilitation techniques involved in early rehabilitation, early rehabilitation period, and the access conditions of medical institutions for early rehabilitation on the basis of the early rehabilitation data of Chengdu, investigation on some domestic rehabilitation institutions, and expert consultation opinions, to provide a scientific basis for the early rehabilitation of relevant medical institutions. Methods We extracted the data of 130 medical insurance designated institutions in Chengdu for the whole year of 2014 (from January 1st to December 31st), and used the investigation method to study eight common types of clinical rehabilitation diseases (except stroke); went out to investigate the data of eight common types of clinical rehabilitation diseases (except burns) of five hospitals; using expert consultation method, collected 15 experts’ opinions on the early treatment of common clinical rehabilitation, intervention time, rehabilitation costs and so on. Results Common techniques for early rehabilitation included: rehabilitation assessment, acupuncture/electroacupuncture treatment, low-intermediate frequency pulse electrotherapy, pneumatic limb blood circulation promotion treatment, joint loosening training, other massage training, aerobic training, exercise therapy, and occupational therapy. In addition, each disease type also corresponded to special rehabilitation techniques. The early rehabilitation period was 13–14 days for persistent vegetative state (hypoxic ischemic encephalopathy), 11–18 days for fractures, 12–14 days for joint and soft tissue injury, 31–47 days for spinal cord injury, 11–18 days for brain injury, 14–19 days for burn (chemical, electric shock), 10–12 days for hand injury, 9–20 days for peripheral nerve injury, and 13–21 days for stroke. The access conditions for early rehabilitation included: general hospitals above the second level, with independent rehabilitation treatment rooms and rehabilitation wards, with early rehabilitation equipment, qualified full-time rehabilitation physicians and therapists. Conclusions In the common technical aspects of early rehabilitation, each disease has a common technology and also corresponds to special rehabilitation techniques. The early rehabilitation period for most diseases is 2–3 weeks. In order to ensure the quality and safety of early rehabilitation, it is recommended to include the hospital level and professional rehabilitation talent qualifications into the access conditions for early rehabilitation.