| Objective:In the pace of the advance of science and technology as well as the advance of medical technology,the life span of human beings has been prolonged compared with that of the last century,and then the incidence of senile diseases has also increased.Intertrochanteric fracture of femur is a kind of hip fracture in the elderly,and it is very harmful,with a mortality rate of more than 20% within one year.Gluteal muscle training and balance ability training are of positive significance to improve the physical fitness,restore the physical function level after injury and improve the bad posture.In view of the positive effects of these two kinds of training on human body,this paper comparatively studies the effects of gluteal muscle training combined with balance ability training for three months on the functional recovery of patients with intertrochanteric fracture of femur,in order to provide theoretical reference for clinical patients with intertrochanteric fracture to adopt scientific functional training and recovery methods.Methods: Forty patients with intertrochanteric fracture after operation were selected from the Department of Orthopaedics,the Seventh Medical Center of PLA General Hospital,and divided into general training group(n=20)and gluteal muscle training combined with balance training group(n=20)according to different rehabilitation training methods.After closed reduction and internal fixation of intertrochanteric fracture of femur,the subjects in both groups received general rehabilitation training and health guidance for 3 months,but the subjects in gluteal muscle training combined with balance ability training need to intervene gluteal muscle training and balance ability training at an appropriate time.One month after operation,X-ray examination,Visual Analogue Scale,VAS)and Timed Up and Go Test(TUG)were performed on the two groups respectively.Three months after the operation,the subjects in the two groups were tested by X-ray examination,VAS pain assessment,TUG test,Two-minute Walk Test,2MWT),functional independence measurement(FIM)scale and Barthel Index for ADL,Barthel index)scale.One person died half a month after operation because of perioperative complications,and five people failed to complete the experiment because of the COVID-19 epidemic.Finally,the number of subjects who received different exercise interventions was 34,18 in the general training group and 16 in the gluteal muscle training combined with balance training group.The experimental data were analyzed by SPSS26.0 and STATA 15.0 SE software,and the generalized estimation equation model of Logit connection function,Binomial distribution and unconstrained correlation working matrix was used to test the inter-group and time factors.Results:1.Three months after operation,the average score of 2MWT in gluteal muscle training combined with balance training group was 48.41 m,which was better than that in general training group(13.00m),and the difference was statistically significant(P < 0.05).Two and three months after operation,the number of people whose TUG score was less than 30 seconds in the gluteal muscle training combined with balance training group was 7 and 9 respectively,which was significantly higher than that in the general training group(2 and 3 respectively,the difference was statistically significant(P < 0.05).There is a positive correlation between the blood Ca level and the TUG score in elderly patients with intertrochanteric fracture of femur(P = 0.009;β=14.2)。2.Three months after operation,the average VAS score of the general training group was 1.11,which was significantly lower than the VAS score of 2.11 one month after operation(P < 0.01).One month after operation,the average VAS score of gluteal muscle training combined with balance training group was 0.69,which was lower than that of general training group(2.11),and the difference was statistically significant(P < 0.01).Three months after operation,the average VAS score of gluteal muscle training combined with balance training group was 0.44,which was lower than that of general training group(1.11),and the difference was statistically significant(P < 0.01).Three months after operation,the VAS score of gluteal muscle training combined with balance training group decreased by 0.25 points,while that of general training group decreased by 1 point.The VAS score of gluteal muscle training combined with balance training group decreased less than that of general training group,with statistical difference(P <0.05).3.Three months after the operation,compared with before the injury,the average score of FIM in gluteal muscle training combined with balance training group decreased by 3.81 points,and that in general training group decreased by 25.78 points.The FIM in gluteal muscle training combined with balance training group decreased slightly compared with the general training group,and the difference was statistically significant(P < 0.001).Three months after operation,compared with before injury,the average score of Barthel index in gluteal muscle training combined with balance training group decreased by 6.25 points,and that in general training group decreased by 28.39 points.The decline score of Barthel index in gluteal muscle training combined with balance training group was lower than that in general training group,and the difference was statistically significant(P<0.001).4.Three months after operation,compared with before operation,the average osteocalcin level in gluteal muscle training combined with balance training group increased from 8.89 ng/ml to 12.98 ng/ml,which was 4.09 ng/ml,with statistical significance(P < 0.01).Three months after operation,compared with before operation,the blood vitamin D levels of gluteal muscle training combined with balance training group and general training group increased to different degrees,which were 6.4 ng/ml and 10.93 ng/ml respectively,with statistical significance(P <0.01).Three months after operation,the blood vitamin D level of gluteal muscle training combined with balance training group was significantly lower than that of general training group,with a difference of 9.9ng/ml,with statistical significance.Compared with pre-operation,the blood level of gluteal muscle training combined with balance training group and general training group increased in different degrees 3 months after operation,and both of them had statistical significance(P <0.01).Conclusion:1.Both general training and gluteal muscle training combined with balance ability training can improve the walking function of elderly patients with intertrochanteric fracture,but the improvement effect of the latter is obviously better than the former;2.General training and gluteal muscle training combined with balance ability training can improve the postoperative pain of elderly patients with intertrochanteric fracture,but the improvement effect of the latter is obviously better than the former one month after operation;3.Gluteal muscle training combined with balance ability training can improve the daily living ability and independence of elderly patients with intertrochanteric fracture after operation,and it is obviously better than general training;4.Gluteal muscle training combined with balance ability training can improve the postoperative blood osteocalcin level of elderly patients with intertrochanteric fracture,but general training can not improve the postoperative blood osteocalcin level of patients with intertrochanteric fracture. |
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