Universal stepwise rehabilitation training promotes the functional recovery of quadriceps femoris after intertrochanteric femoral fracture surgery
Wang Chunhong, Lu Ming
Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
Abstract: BACKGROUND: If quadriceps femoris muscle is not effectively rehabilitated, the strength of quadriceps femoris muscle in patients with intertrochanteric fractures will gradually decline, even causing lower limb muscle atrophy. As a result, postoperative complications such as pain in the affected thigh and inflexibility of the hip and knee joints will occur.
OBJECTIVE: To evaluate the effect of universal stepwise rehabilitation training of quadriceps femoris muscle on the postoperative rehabilitation of intertrochanteric fracture of the femur, and to investigate the efficacy of quadriceps femoris rehabilitation in the postoperative rehabilitation of intertrochanteric fractures of the femur.
METHODS: A retrospective analysis was performed to analyze the data of 48 patients operated for intertrochanteric fracture of the femur who were rehabbed by applying a quadriceps femoris rehabilitation program between October 2016 and February 2022. Rehabilitation training included isotonic and isometric contraction training of quadriceps femoris muscle, and the time of exercise was from the 1st to the 12th week of the postoperative period. Patient’s Hip function was evaluated using hip joint mobility score in Merle D'Aubigne and Postel evaluation system, WOMAC lower extremity function score, and Harris hip joint function score. The Visual Analog Scale was used to assess patients’ pain. The Hospital Anxiety and Depression Scale was used to assess the patient’s psychological status. Changes in quadriceps muscle strength were also measured.
RESULTS AND CONCLUSION: The average healing time of the fracture was (9.78±1.65) weeks. At 4 weeks postoperatively, the patient’s hip function significantly improved compared with that at the preoperative period (P < 0.01), the Visual Analog Scale scores for pain evaluation decreased (P < 0.01), quadriceps femoris muscle strength increased (P < 0.01), and the Hospital Anxiety and Depression Scale scores decreased (P < 0.05). At 12 weeks postoperatively, as the rehabilitation training continued, the patient's hip function and pain symptoms further improved compared with those at 4 weeks postoperatively (P < 0.05), quadriceps femoris muscle strength further recovered (P < 0.05), and the Hospital Anxiety and Depression Scale scores further decreased (P < 0.01). At 24 weeks postoperatively, the rehabilitation training had been stopped, the patient’s hip joint function and muscle strength were well maintained, and no obvious amyotrophy occurred in the quadriceps femoris muscle, and there were no significant differences between 12 and 24 weeks postoerpatively (P > 0.05). No complications and adverse events occurred during postoperative rehabilitation. To conclude, the application of universal stepwise functional rehabilitation model of quadriceps femoris muscle in the early postoperative period of intertrochanteric formal fracture is helpful for the recovery of hip joint function, increasing muscle strength, and promoting fracture healing to a certain extent.
Key words: functional rehabilitation model, accelerated rehabilitation, intertrochanteric femoral fracture, universal rehabilitation concept, stepwise rehabilitation model, postoperative rehabilitation