肩胛骨骨折治疗方法的选择及临床疗效对比分析

发布时间：2018-06-01 00:03

本文选题：肩胛骨骨折 + 手术　；参考：《山东中医药大学》2015年硕士论文

【摘要】：目的:对肩胛骨骨折的治疗方法的选择及临床效果进行分析与比较,进而有效探讨肩胛骨骨折的分型、诊断和具体治疗方法,以实现不同类型肩胛骨骨折的最佳治疗。资料与方法:回顾我院骨科在2004年1月-2014年4月收治的48例肩胛骨骨折患者。其中,男性33例,女性15例。依据Hardegger的骨折分型,对骨折进行分类:体部骨折14例,肩胛颈骨折8例(解剖颈骨折3例,外科颈骨折5例),肩胛盂骨折11例(盂窝骨折5例,盂缘骨折6例),肩峰骨折3例,喙突骨折4例,肩胛冈骨折5例,粉碎性骨折3例。在这些骨折的治疗中,采用非手术治疗有32例,手术治疗的有16例,其中非手术治疗组中有10例具备手术指征但未行手术治疗。因此我们将这48例患者分成三组,第一组为非手术组中移位较轻不具备手术指征的22例,第二组为非手术组中具备手术指征但未行手术治疗的10例,第三组为手术组。其中稳定的没有移位或者移位轻微的骨折我们均采用非手术治疗,对移位较大不稳定性的肩胛骨骨折,我们10例(具备手术指征)采用非手术治疗,16例采用手术治疗。本文使用Hardegger功能评定方法对不同类型的肩胛骨骨折治疗效果进行评定,发现稳定的没有移位或者轻微移位的肩胛骨骨折经过非手术治疗优良率较高,移位较大不稳定性的肩胛骨骨折手术组优良率明显高于非手术组(10例具备手术指征但未行手术治疗),同时手术组的并发症发生率低于非手术组(10例具备手术指征但未行手术治疗)。结果:随访手术组与非手术组的病例3-12个月,对每个患者的随访时间是26个周。通过治疗,基本上所有的患者都愈合了,平均愈合时间是1.5-3个月。按照Hardegger功能评定原则,非手术治疗第一组22例:优20例、良1例、可1例、差0例。非手术治疗第二组10例(具备手术指征但未行手术治疗):优1例、良2例、可2例、差5例。手术组16例:优12例、良2例、可1例、差1例。从并发症来看,第二组(具备手术指征但未行手术治疗)的并发症的发生率要显著高于第一组和手术组的并发症发生率。结论:在本研究中,稳定的没有移位或者移位轻微的肩胛骨骨折通过非手术治疗能够达到满意的愈后效果,对于移位较大不稳定性的肩胛骨骨折手术治疗与非手术治疗疗效存在明显差异,因此通常情况下稳定的没有移位或者移位轻微的肩胛骨骨折可以采用常规非手术治疗,但对于移位较大不稳定性的肩胛骨骨折的病例,运用手术治疗能达到更好的临床效果,而且并发症也较少。在临床中,可以根据骨折的部位、类型、移位情况决定治疗方案。
[Abstract]:Objective: to analyze and compare the treatment methods and clinical effects of scapular fractures, and to explore effectively the classification, diagnosis and treatment of scapular fractures in order to achieve the best treatment of different types of scapular fractures. Materials and methods: 48 cases of scapular fractures treated in our department of orthopedics from January 2004 to April 2014 were reviewed. Among them, 33 cases were males and 15 cases were females. According to Hardegger's fracture classification, 14 cases of body fracture, 8 cases of scapular neck fracture (3 cases of anatomical neck fracture, 5 cases of surgical neck fracture), 11 cases of scapular pelvic fracture (5 cases of pelvic fossa fracture, 6 cases of glenoid margin fracture, 3 cases of acromion fracture) were classified. There were 4 cases of coracoid process fracture, 5 cases of scapular fracture and 3 cases of comminuted fracture. In the treatment of these fractures, 32 cases were treated with non-operative treatment, and 16 cases were treated surgically. In the group of non-operative treatment, 10 cases had the indication of operation but did not undergo surgical treatment. Therefore, we divided the 48 patients into three groups. The first group was 22 cases with light displacement and no indication of operation, the second group was 10 cases of non-operative group without surgical treatment, and the third group was operation group. Among them, the stable fractures with no displacement or slight displacement were all treated by non-surgical treatment. For the scapular fractures with greater instability, 10 of us (with surgical indications) were treated with non-surgical treatment in 16 cases. Hardegger functional evaluation method was used to evaluate the therapeutic effects of different types of scapular fractures. It was found that stable scapular fractures without or slightly displaced scapular fractures had a higher rate of excellent and good results after non-operative treatment. The excellent and good rate of scapular fracture with greater instability of displacement was significantly higher in the operative group than in the non-operative group. The incidence of complications in the operative group was lower than that in the non-operative group, and the incidence of complications in the operative group was lower than that in the non-operative group. But no surgical treatment was performed. Results: each patient was followed up for 26 weeks for 3-12 months in both operative and non-operative groups. After treatment, almost all patients healed, with an average healing time of 1. 5-3 months. According to the principle of Hardegger functional evaluation, 22 cases in the first group of non-operative treatment were excellent in 20 cases, good in 1 case, fair in 1 case, and poor in 0 cases. In the second group, there were 10 cases (1 excellent, 2 good, 2 fair and 5 poor) with the indication of operation but not with the surgical treatment, which were excellent in 1 case, good in 2 cases, fair in 2 cases and poor in 5 cases. In the operation group, 12 cases were excellent, 2 cases were good, 1 case was fair, and 1 case was poor. In terms of complications, the incidence of complications in the second group was significantly higher than that in the first group and the operative group. Conclusion: in this study, stable undisplaced or slightly displaced scapular fractures can achieve satisfactory results through non-surgical treatment. There was significant difference between operative treatment and non-operative treatment for scapular fractures with greater displacement instability. Therefore, in general, stable scapular fractures with no displacement or slight displacement can be treated with conventional non-surgical treatment. But for patients with scapular fractures with greater displacement instability, surgical treatment can achieve better clinical results and fewer complications. In clinic, the treatment plan can be determined according to the site, type and displacement of fracture.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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