Efficacy Of Postsurgical Ambulation’s Start-time On Rehabilitation In Patients With Acetabular And Ipsilateral Femoral Fracture After Surgery

Objective: Acetabular fracture with ipsilateral femur fracture is a seriousmultiple injuries caused by high-energy violence, using open reduction andinternal fixation as the treatment. The ultimate goal of the treatment is toobtain a satisfactory hip function, which is very important to the patients’ lifequality. To achieve this goal, it demands both successful suegical treatmentand proper postsurgical rehabilitation exercises. The comprehensive studies onpostsurgical rehabilitation exercises of such patients have been barely reportedso far. The study is designed to do the follow-up of the patients, and recordtheir postsurgical ambulation’s start-time （partial weight bearing） and hipfunction state, to investigate the relationship between postsurgicalambulation’s start-time and the hip joint function rehabilitation.Methods: Queried the record of acetabular fracture patient treated in ourhospital from2007to2011by using medical record query system, selectedpatients of acetabular fractures and ipsilateral femoral fractures treated withopen reduction and internal fixation, eliminated patients with severe injury ofbrain and viscera, got37patients’ medical record. The37patients had theirincision healed well, hadn’t developed infection or deep vein thrombosis oflower limbs before discharged. Did the follow-up of the patients, asked theirpostsurgical ambulation’s start-time, evaluated their hip function by usingHarris Score System, and got Harris score and standard （excellent, good, fair,poor）. Grouped the patients by their postsurgical ambulation’s start-time （t）,and got3groups as: group A （t≤2months）, group B （2months <t≤3months）, group C （t>3months）, and got the Harris excellent-good rate ofeach group. SPSS13.0statistical software were used for statistical dataprocessing. χ²test were used to compare the Harris excellent-good rate of each group. Set P <0.05is significant when comparing among3groups, and P＇<0.0167is significant when comparing among any2groups.Result:37patients got follow-up. The follow-up time waved in the limitsfrom14-month to66-month, and the average follow-up time is44.9months.15patients had taken periodic review after discharged, started theirpostsurgical ambulation （partial weight bearing） within2months （0.5²months） as guided. The rest22patients hadn’t taken periodic review afterdischarged, didn’t follow the guide, rested at home and started postsurgicalexercise on their own mind. Of the22patients,12patients started postsurgicalambulation （partial weight bearing） after2months but within3months,10patients rested on bed until after3month （3¹2months） after surgery. Untilthe last time the patients was followed-up, all the patients’ fracture had beenhealed, and the patients had a stable hip function with a normal living state.Got the Harris score and standard of each group. Group A’s average score is89.3（78⁹9）, has6excellent,7good, and2fair, the excellent-good rate is86.7%（13/15）. Group B’s average score is82.2（71⁹7）, has2excellent,3good, and7fair, the excellent-good rate is41.7%（5/12）. Group C’s averagescore is77.3（70⁸6）, has1excellent,3good, and6fair, the excellent-goodrate is40.0%（4/10）. Using SPSS13.0statistical software for statistical dataprocessing. Using χ²test to compare the difference of the excellent-good rateamong3groups, the result showed that the difference was significant (χ²_ABC=7.854，PABC=0.024). Using partition of χ²test to compare the differencebetween any2groups’ excellent-good rate, the difference between group Aand B was significant (χ²_ABC=7.854，PABC=0.024), the difference betweengroup A and C was significant (χ²_AC=6.005，P＇AC=0.014), the differencebetween group B and C wasn’t significant (χ²_BC=0.006，P＇_BC=0.937). Theresult showed that group A was better than the other two groups, and there wasno significant difference between group B and C.Conclusion: The result of this study will be valuable for rehabilitationof the patients with acetabular and ipsilateral femoral fracture. For suchpatients, besides open reduction and rigid internal fixation, early postsurgical ambulation exercise （partial weight bearing） is conducive to the hip recovery.Patients who started postsurgical ambulation exercise （partial weight bearing）within2months after surgery will have better result than those started after2months.