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保守治疗桡骨远端骨折后年龄大于 60 岁的复杂性区域疼痛综合征 1 型患者的功能结局相关的基线预测因素:一项前瞻性观察研究。

Baseline predictors related to functional outcomes in patients older than sixty years with complex regional pain syndrome type 1 after distal radius fracture treated conservatively: a prospective observational study.

机构信息

Clínica Indisa, Santiago, Chile.

Instituto Traumatológico, Santiago, Chile.

出版信息

Int Orthop. 2023 Sep;47(9):2275-2284. doi: 10.1007/s00264-023-05880-0. Epub 2023 Jul 13.

Abstract

PURPOSE

This study aimed to analyze baseline predictors of functional outcomes six weeks and at one year follow-up in patients older than 60 years with complex regional pain syndrome type 1 (CRPS I) after distal radius fracture (DRF).

METHODS

A total of 120 patients with CRPS I after DRF were prospectively recruited. Presumptive relevant factors were collected and analyzed as potential baseline predictors. Additionally, functional outcomes were assessed at the beginning of physiotherapy treatment, at six weeks after finishing physiotherapy treatment, and at one year follow-up. Patient-Rated Wrist Evaluation; Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; Jamar dynamometer; and visual analog scale (VAS) were assessed.

RESULTS

All participants completed the study. At 6 weeks, the main results showed an association of lower values of grip strength with female sex (p = 0.010), intra-articular DRFs (p = 0.030), longer immobilization time (p = 0.040), lower levels of physical activity (p < 0.001), higher levels of kinesiophobia (p = 0.010), and anxiety (p = 0.020). At 1-year follow-up, the results showed an association of lower values of DASH with higher BMI (p < 0.001) and longer immobilization time (p < 0.001); and higher values of VAS showed an association with older age (p = 0.010), higher BMI (p = 0.010), and lower levels of physical activity (p = 0.040).

CONCLUSION

At six weeks, factors such as BMI, immobilization time, physical activity, and kinesiophobia are associated with lower functional outcomes. Additionally, at one year follow-up, BMI, immobilization time, and physical activity continue to be associated with lower functional outcomes in patients with CRPS I after DRF treated conservatively.

摘要

目的

本研究旨在分析年龄大于 60 岁、伴有桡骨远端骨折(DRF)的复杂性区域疼痛综合征 1 型(CRPS I)患者在接受治疗后 6 周和 1 年随访时的功能结局的基线预测因素。

方法

共前瞻性招募了 120 例伴有 CRPS I 的 DRF 患者。收集了推定的相关因素,并对其进行分析,作为潜在的基线预测因素。此外,在开始物理治疗时、完成物理治疗后 6 周和 1 年随访时评估功能结局。采用患者腕部评估量表(Patient-Rated Wrist Evaluation)、上肢残疾问卷(Disabilities of the Arm, Shoulder, and Hand,DASH)问卷、Jamar 握力计和视觉模拟量表(visual analog scale,VAS)进行评估。

结果

所有参与者均完成了研究。6 周时,主要结果显示,握力较低与女性(p = 0.010)、关节内 DRF(p = 0.030)、更长的固定时间(p = 0.040)、较低的体力活动水平(p < 0.001)、更高的运动恐惧水平(p = 0.010)和焦虑水平(p = 0.020)有关。1 年随访时,结果显示 DASH 评分较低与 BMI 较高(p < 0.001)和固定时间较长(p < 0.001)有关;而 VAS 评分较高与年龄较大(p = 0.010)、BMI 较高(p = 0.010)和体力活动水平较低(p = 0.040)有关。

结论

在 6 周时,BMI、固定时间、体力活动和运动恐惧等因素与功能结局较差有关。此外,在 1 年随访时,BMI、固定时间和体力活动仍与接受保守治疗的 DRF 后 CRPS I 患者的功能结局较差有关。

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