| Objective:In order to work out a better solution for the rehabilitation of the postoperative unstable ankle fracture patients, the research compared and evaluated the the influences to the functional recovery and fracture union situation by observing two groups of patients, one of which had early exercise and weight training, while the other one had a two-week plaster fixation.Method:In the prospective randomized controlled study,40 postoperative unstable ankle fracture cases from April to December of 2009 in accordance with the indrawing standard were chosen to be the objective of the research. Numberized according to the admission order, the patients were randomized divided into treatment group and contol group, with 20 cases in each group. All the patients received open reduction and internal fixation(ORIF) according to the AO/ ASIF principles, after which both group had a two-week plaster fixation.The treatment group had early exercise, weight training and the other functional exercise, while the control group only took the related functional exercise. The functional recovery was evaluated in terms of the engorgement score, Visual Analog Scale score(VSA score), hospital stay time, full weight training time,return-to-work time, Baird-Jackson score, and AOFAS score,all of which were then statistically analyzed.Results:1. All patients in the treatment group and control group finished follow-ups for 6 months. The two groups had no obvious variance in gender, age, body weight, type of fracture and time of hospitalization.2. The engorgement score of the two groups at the time of 24 hours,7 days and 14 days after the surgery had no obvious variance, which in the treatment group were (2.77±0.26) cm, (1.92±0.24) cm and (0.81±0.13) cm, while in the control group were (2.78±0.18) cm, (1.99±0.25) cm and (0.86±0.14) cm. Besides, there was no obvious variance in engorgement relief score in the 14th postoperative day. The VSA score of the 3rd,7th and 14th postoperative day were (7.05±0.51), (5.00±0.61), (3.05±0.69) in the treatment group and (7.00±0.64), (5.07±0.46), (3.15±0.67) in the control group.3. In aspect of ankle-function recovery, the treatment group was obviously superior to the control group in the long-term evaluation. After 3 months of the surgical treatment, Baird-Jackson score in the treatment group was (75.95±5.84), which, though a bit higher than the control group, had no variance group (P=0.250). The AOFAS score in the treatment group was (78.70±6.70) which had no obvious variance (P=0.561) compared with the control group. In the 6-month follow-up after the surgery:the Baird-Jackson score was (94.15±6.03) in the treatment group and a bit higher than (89.45±8.28) in the control group, which had obivous variance(P=0.047);the AOFAS score was (90.75±8.96) in the treatment group and (83.25±8.72) in the control group, which had obvious variance (P=0.011);the total weight-bearing time was (8.00±0.86) weeks in the treatment group and (8.65±0.99) weeks in the control group, which had obivious variance(P=0.032).All the patients in the follow-ups have returned to normal life and work, the time of which was (8.95±0.84) weeks in the treatment group and (9.60±0.98) weeks in the control group, showing that the two groups had obivious variance (P=0.030). Both groups have achieved bony union.Conclusion:1. The early exercise and plaster fixation were both good methods for the functional recovery of the unstable ankle fractures after surgical treatment.2. Compared with the plaster fixation method, the early postoperative exercise have the merits as promoting blood and lymphatic circulation, improving microcirculation, helping recover the muscle function and preventing the muscle atrophy. The total weight-bearing time in early weight training group was shorter than that of the immobilization group, which helped the patients to return to work sooner. But the forward effects needs further study.3. The functional rehabilitation method of treatment group has its feasibility and advantages for ankle postoperative patients, especially in the long-term effect. Early weight training and exercise can be recommended for patients who have got a stable osteosynthesis of their fractured ankles and have fine compliance. |
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