Simmel Stefan
Rehabilitation (Stuttg). 2018 Apr;57(2):127-137. doi: 10.1055/s-0043-124397. Epub 2018 Apr 16.
Many polytrauma patients report significant long-term impairments to their physical and mental health, resulting in a reduction of their quality of life. In addition to the obvious physical accident sequences, psychological influences and the individual context factors pose special challenges to the rehabilitation team and the infrastructure of the facility. Professional reintegration and chronic pain are particularly common problems in the trauma rehabilitation. The central task of rehabilitation after accidents is the restoration or substantial improvement of the functional health and thus the reintegration into the social and professional environment. The overall rehabilitation goal is based on the biopsychosocial ICF model: the patient should achieve the best possible quality of life despite his functional impairments, and the workability and functional capability are to be restored as well as possible. This goal can only be reached after a lengthy process, in the course of which differentiated measures must be coordinated. This is the task of experienced doctors, therapists and rehabilitation managers, who accompany the patient permanently. The rehabilitation after serious accidents is to be distinguished from the "normal" orthopedic rehabilitation after elective interventions. The challenges of traumatic rehabilitation require special processes, infrastructures, as well as interrelated and coordinated rehabilitation phases. The three-phase model described in the "Weißbuch Schwerverletztenversorgung der DGU" has to be differentiated. Between the discharge from the acute care clinic and the beginning of the post-acute rehabilitation, a "rehabilitation hole" frequently occurs. The early rehabilitation, by definition, a part of the acute treatment, cannot adequately close this hole. A 6-phase model is proposed. Phase C of post-acute rehabilitation places particular demands on the rehabilitation facility. The further rehabilitation (phase E) provides specific measures, such as pain rehabilitation or activity-oriented procedures. A long-term follow-up of formerly seriously injured patients is necessary (phase F). An integration of trauma rehabilitation centers into the existing trauma network remains the long-term goal to improve the outcome after polytrauma.
许多多发伤患者报告称其身心健康存在严重的长期损伤，导致生活质量下降。除了明显的身体损伤后果外，心理影响和个体背景因素给康复团队及康复机构的基础设施带来了特殊挑战。职业再融入和慢性疼痛是创伤康复中尤为常见的问题。事故后康复的核心任务是恢复或大幅改善功能健康，从而重新融入社会和职业环境。整体康复目标基于生物心理社会的国际功能、残疾和健康分类（ICF）模型：尽管患者存在功能损伤，但应尽可能实现最佳生活质量，并尽可能恢复工作能力和功能。这一目标只有经过漫长过程才能实现，在此过程中必须协调各种不同的措施。这是经验丰富的医生、治疗师和康复管理人员的任务，他们要长期陪伴患者。严重事故后的康复与择期干预后的“常规”骨科康复有所不同。创伤康复的挑战需要特殊的流程、基础设施以及相互关联且协调的康复阶段。必须区分德国创伤外科学会（DGU）《重伤员救治白皮书》中描述的三阶段模型。在从急症诊所出院到急性后期康复开始之间，经常会出现一个“康复缺口”。从定义上讲，早期康复作为急性治疗的一部分，无法充分填补这个缺口。本文提出了一个六阶段模型。急性后期康复的C阶段对康复机构有特殊要求。进一步的康复（E阶段）提供了特定措施，如疼痛康复或以活动为导向的程序。对曾受重伤患者进行长期随访是必要的（F阶段）。将创伤康复中心纳入现有的创伤网络仍是改善多发伤预后的长期目标。
