运用BCFS手术治疗与夹板固定保守治疗A3、B1型肱骨近端骨折的临床疗效对比研究

发布时间：2018-01-24 08:52

本文关键词： A3 B1型肱骨近端骨折桥接组合式内固定系统手法复位超肩关节夹板　出处：《云南中医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的：针对肱骨近端骨折在治疗方法上存在的诸多争议,本课题通过运用桥接组合式内固定系统(Bridge combined fixation system,BCFS)手术治疗与手法复位超肩关节夹板固定保守治疗肱骨近端骨折,对其临床治疗效果进行对比,分析两种治疗方案存在的优缺点及影响疗效的各方面因素,从而为临床治疗肱骨近端骨折提供一种有效的治疗方案,并为选择治疗方案提供一定的科学依据。方法：本课题于2013年03月至2014年11月在昆明医科大学附属延安医院及昆明市中医院骨科,收集符合纳入标准的肱骨近端骨折病例30例。按照随机分配原则分为两组,即A组(BCFS手术治疗组)、B组(手法复位超肩关节夹板固定保守治疗组)各15例,A组平均年龄58.27±8.413岁,B组平均年龄60.33±6.810岁。临床随访6-11个月,平均随访7.94±1.524个月。观察治疗后骨折对位、骨痂生长、肩关节功能恢复情况,并采用SPSS19.0统计学软件统计分析各项数据。结果：两组在年龄、性别、受伤机制、骨折分型上无明显差异。治疗6月后通过Constant Murley肩关节功能评定,两组在肩关节疼痛与屈曲上P0.05,无显著性差异。两组在肩关节日常生活受限,肩关节的外展、内旋、外旋、拉力,肩关节活动总分及肩关节功能评定总分上P0.05,A组优于B组,有显著性差异。A组在患肩与健肩的肩关节功能评定自身比较上P0.05,患肩与健肩无显著性差异;B组在患肩与健肩的肩关节功能评定自身比较上P0.05,有显著性差异,健肩明显优于患肩。通过骨痂生长评判标准,在骨痂生长上,两组治疗1月和3月后P0.05,A组优于B组,有显著性差异;6月后P0.05,无显著性差异。通过骨折复位优良标准,在骨折端对位上P0.05,A组优于B组,有显著性意义。结论： BCFS手术治疗相对手法复位超肩关节夹板固定保守治疗A3、B1型肱骨近端骨折,在肩关节功能恢复上更好,骨折的复位更为满意,骨痂的生长更快,临床的疗效更为显著。
[Abstract]:Objective: to discuss the treatment of proximal humerus fracture. In this paper, bridge combined fixation system is used to bridge the internal fixation system. Treatment of proximal humeral fractures by BCFS was compared with that of manipulative reduction and fixation of superscapulohumeral splints. The advantages and disadvantages of the two treatment schemes and the factors affecting the curative effect were analyzed so as to provide an effective treatment for the proximal humeral fracture. Methods: from March 2013 to November 2014, this study was conducted in the Department of Orthopaedics, Yan'an Hospital, Kunming Medical University and Kunming traditional Chinese Medicine Hospital. Thirty patients with proximal humerus fractures who met the inclusion criteria were collected and divided into two groups according to the principle of random distribution: group A: BCFS surgical treatment group. The average age of group A was 58.27 卤8.413 years. The average age of group B was 60.33 卤6.810 years old. The clinical follow-up was 6-11 months and the average follow-up was 7.94 卤1.524 months. The recovery of shoulder function was analyzed by SPSS19.0 statistical software. Results: the age, sex and injury mechanism of the two groups were analyzed. There was no significant difference in fracture classification. After treatment June, Constant Murley shoulder function evaluation, the two groups in shoulder pain and flexion P0.05. There was no significant difference between the two groups. Group A was superior to group B in terms of limited daily life of shoulder joint, shoulder abduction, internal rotation, external rotation, pull force, total score of shoulder joint activity and total score of shoulder joint function evaluation. There was significant difference. Group A had no significant difference in the self-evaluation of shoulder joint function between the affected shoulder and the healthy shoulder (P0.05), but there was no significant difference between the affected shoulder and the healthy shoulder. In group B, there was a significant difference in the evaluation of shoulder joint function between the affected shoulder and the healthy shoulder, and the healthy shoulder was superior to the affected shoulder, and the callus growth was evaluated according to the criteria of callus growth. After January and March, group A was better than group B in the treatment of P0.05A, and there was a significant difference between the two groups. After June, there was no significant difference between group A and group B. according to the fine standard of fracture reduction, group A was better than group B on the end of fracture. Conclusion: compared with manual reduction and superscapulohumeral splint fixation, BCFS is better in the treatment of proximal humerus fracture of type A _ (3) and B _ (1), which is better in the recovery of shoulder joint function. The reduction of fracture is more satisfactory, the callus grows faster, and the clinical effect is more remarkable.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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