Brink P R G, Verleisdonk E J M M, Blokhuis T J
MUMC+, afd. Traumatologie, Maastricht.
Ned Tijdschr Geneeskd. 2017;161:D1533.
Almost all the literature dictates a period of non-weight-bearing after surgical treatment of articular and peri-articular fractures of the pelvis and lower extremities. This is followed by partial weight-bearing which is based on the number of weeks after surgery. However, none of these recommendations are based on evidence. When taking muscle force and gravity into account, non-weight-bearing is actually impossible. In addition, lack of patient compliance, lack of muscle force in the elderly and four-fold energy expenditure make it almost impossible to ensure that patients will adhere to their surgeon's restrictions. Based on our experiences in a large cohort of patients with fractures of the pelvis and lower extremities, we see no drawbacks in permissive weight-bearing and early recovery in most cases. We strongly believe that most patients are able to listen to their body and understand body awareness, while the creation of a safe environment makes more personalised follow-up treatment possible.
几乎所有文献都表明,骨盆和下肢关节及关节周围骨折手术治疗后需要一段时间不负重。之后是部分负重,这取决于术后的周数。然而,这些建议均无证据依据。考虑到肌肉力量和重力,实际上不可能做到完全不负重。此外,患者依从性差、老年人肌肉力量不足以及能量消耗增加四倍,几乎无法确保患者会遵守外科医生的限制。基于我们在大量骨盆和下肢骨折患者中的经验,我们发现在大多数情况下允许负重和早期恢复并无弊端。我们坚信大多数患者能够听从身体的声音并理解身体感知,而营造一个安全的环境则使更个性化的后续治疗成为可能。