肱骨远端C型骨折术后不同时期及不同制动体位功能锻炼的临床随机对照研究

发布时间：2018-06-28 02:53

本文选题：肱骨远端骨折 + C型　；参考：《四川医科大学》2015年硕士论文

【摘要】：目的：本实验期望通过前瞻性随机对照研究证实肱骨远端C型骨折术后即刻功能锻炼与术后石膏制动1周后开始肘关节功能锻炼对肘关节功能康复是否存在差异,并进一步证实术后不同体位制动1周对肘关节功能恢复是否存在差异。为肱骨远端C型骨折的术后康复提供一条更全面、有效的方法。方法：本研究拟选择2013年6月至2014年7月期间四川省人民医院骨科以及双流县第一人民医院骨科共90例肱骨远端C型骨折手术病人,并随机分为3组。A组：术后即刻开始肘关节功能锻炼。30例,其中男16例,女14例,平均年龄38.4+13.26岁。AO分型：C1型8例,C2型16例,C3型6例。手术时间：伤后1-3天手术者：2例,伤后4-7天手术者：26例,伤后8-14天手术者：2例：B组：术后石膏外固定于屈肘90。位制动1周后开始肘关节功能锻炼。30例,其中男19例,女11例,平均年龄39.43+13.27岁。AO分型：C1型9例,C2型15例,C3型6例。手术时间：伤后1-3天手术者：1例,伤后4-7天手术者：27例,伤后8-14天手术者：2例；C组：术后石膏外固定于屈肘30。位制动1周后开始肘关节功能锻炼。30例,其中男17例,女13例,平均年龄40.97-+11.87岁。AO分型：C1型10例,C2型15例,C3型5例。手术时间：伤后1-3天手术者：2例,伤后4-7天手术者：27例,伤后8-14天手术者：1例。观察患者的疼痛情况,肘关节活动度等功能情况,选用Mayo肘关节功能评分系统进行评定三组患者肘关节总体功能恢复情况,选用疼痛视觉类比评分(VAS)评定患者的疼痛程度,采用量角器测量患者肘关节屈伸以及前臂旋转活动范围。结果：术后90例患者均获得随访,随访时间6月-21月。A组30例患者中术后平均8-12周达临床愈合,所有切口均一期愈合,其中2例发生肘部骨化性肌炎表现,2例创伤性关节炎,1例伤口红肿,对症治疗后伤口红肿好转。B组30例患者中术后平均7-12周达临床愈合,所有切口均一期愈合,其中3例发生肘部骨化性肌炎表现,1例伤口红肿,对症治疗后伤口红肿好转。C组30例患者中术后平均9-12周达临床愈合,所有切口均一期愈合,其中3例发生肘部骨化性肌炎表现。结论：肱骨远端C型骨折术后肘关节短期制动后再与功能锻炼,虽然术后2周疼痛较即刻功能锻炼者明显,但术后6月在肘关节Mayo评分、疼痛视觉评分(VAS)、肘关节屈伸活动等方面在一定程度上优于即刻功能锻炼者。肱骨远端C型骨折术后肘关节短期制动与即刻功能锻炼者在影响前臂旋转功能上无明显差别。肱骨远端C型骨折术后屈肘90度短期制动与屈肘30度短期制动,术后6月,在肘关节Mayo评分、疼痛视觉评分(VAS)、肘关节屈伸活动度、前臂旋转活动度等方面无明显差别。肱骨远端C型骨折术后CPM机早期介入,循序渐进的增强主动、被动功能锻炼可以促进患肢的静脉回流,减轻肿胀,防止静脉血栓形成,提高肌力以及关节活动度,减轻周围组织粘连,改善关节功能状态。肱骨远端C型骨折术中结合使用两枚非平行钢板以及螺钉、克氏针可以有效的固定骨折块,增加骨折稳定性,有利于早期的功能锻炼。肱骨远端C型骨折术后功能锻炼需要在临床医生的指导下,循序渐进,术后短期制动有利于减轻水肿,减少创口出血、局部肿胀、疼痛等,有利于患者肘关节功能恢复。
[Abstract]:Objective: the purpose of this study is to verify whether there is a difference in elbow function rehabilitation between the elbow joint functional exercise after 1 weeks after 1 weeks after the operation of the distal humeral fracture and after 1 weeks after the operation, and further confirms whether there is a difference between the 1 weeks after the operation for the recovery of the function of the elbow joint. The postoperative rehabilitation of type C fracture of the distal humerus provides a more comprehensive and effective method. Methods: This study was to choose 90 patients with C fracture of distal humerus in Department of orthopedics, Sichuan Provincial People's Hospital and the first people's Hospital in Shuangliu County from June 2013 to July 2014, and randomly divided into 3 groups of.A groups: the elbow joint work was started immediately after the operation. We can exercise.30 cases, including 16 males and 14 females, and the average age 38.4+13.26 years.AO classification: C1 type 8 cases, C2 type 16 cases, and C3 type 6 cases. The operation time: 2 cases and 4-7 days after injury: 26 cases, 8-14 days after injury: B group: Gypsum external fixation is fixed at elbow 90. position after 1 weeks and starts elbow joint functional exercise.3 0 cases, of which 19 were male and 11 women, the average age of.AO was 39.43+13.27 years old: 9 cases of type C1, 15 cases of C2 type, and 6 cases of C3 type. The operation time: 1 cases, 27 cases, 27 cases, 27 cases, 4-7 days after injury, 2 cases, and C group: the postoperative.30 cases of elbow joint function exercise started after the operation of gypsum outside the elbow flexion 30...30 cases of elbow joint function exercise began after the operation. There were 17 males and 13 females with the average age of 40.97-+11.87 years.AO classification: 10 cases of C1 type, 15 cases of type C2, 5 cases of C3 type. The operation time: 2 cases and 4-7 days after injury: 27 cases, 8-14 days after injury: 1 cases. The function of the pain and elbow joint activity of the patients were observed and the Mayo elbow joint function scoring system was selected. The total function recovery of the three groups of the three groups was evaluated. The pain degree of the patients was assessed by the visual analogue score (VAS). The protractor was used to measure the elbow flexion and extension of the patients and the range of the forearm rotation. Results: 90 patients were followed up after the operation, and the average follow-up time was 8-12 Zhou Dalin in the group of 30 patients in the group of 30 -21 months of June. There were 2 cases of ossifying myositis in the elbows, 2 cases of traumatic arthritis, 1 cases of red and swollen wound, 1 cases of wound redness and swelling after treatment, 30 patients in group.B were healed on average 7-12 weeks after operation, all incisions healed in one period, 3 cases of elbows with ossifying myositis, 1 cases of red and swollen wounds. The wound redness and swelling after symptomatic treatment improved in group.C, the average 9-12 weeks after operation in group.C was healed on average, all incisions healed in one stage, of which 3 cases had elbital ossifying myositis. Conclusion: after the distal C fracture of the humerus, the elbow joint was again after the short-term braking and functional exercise, although the pain was more obvious after 2 weeks after the operation than the immediate functional exercise. In June, the Mayo score of the elbow joint, the pain visual score (VAS), the flexion and extension of the elbow are better than the immediate functional exercise. There is no obvious difference between the short-term braking of the elbow joint and the immediate functional exercise after the operation of the distal humerus type fracture and the immediate function of the forearm. The 90 degree of elbow flexion after the distal humerus C fracture There was no significant difference in the Mayo score of elbow joint Mayo, visual score of pain (VAS), flexion and extension activity of elbow joint and the rotation of forearm in June after operation. There was no significant difference between the elbow joint flexion and extension activity and the forearm rotation activity in June. The early intervention of the CPM machine after the operation of the distal humerus type C fracture was progressively enhanced, and the dynamic exercise could promote the venous return of the affected limbs and reduce the swelling. To prevent venous thrombosis, improve muscle strength and joint activity, reduce surrounding tissue adhesion and improve joint function state. Combined use of two non parallel plates and screws, Kirschner pin can effectively fix fracture blocks, increase fracture stability and facilitate early functional exercise. C type fracture distal to the humerus in the distal humerus C fracture. The postoperative functional exercise needs to be step-by-step under the guidance of the clinician. Short-term postoperative braking is beneficial to reduce edema, reduce wound bleeding, local swelling, pain and so on, which is beneficial to the recovery of the elbow joint function.
【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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