小夹板与锁定钢板治疗肱骨外科颈骨折的疗效比较
发布时间：2018-11-12 17:55
【摘要】：目的:对比手法整复小夹板固定与锁定钢板内固定治疗肱骨外科颈骨折的疗效,对临床治疗肱骨近端骨折提供参考资料。方法:回顾性分析湖北省中医院骨科在2014年3月~2016年3月期间,根据纳入标准、排除标准,选取的47例肱骨外科颈骨折患者。依据治疗方案不同分为手法整复小夹板固定组和肱骨近端锁定钢板内固定组。所有患者均在医师指导下积极功能锻炼并配合中药辩证内治法及中药熏洗治疗。观察并比较两组复位情况,临床愈合时间,治疗后1、3、6个月肩关节功能评分(Constant-Murley评分)及治疗后6个月肩关节功能评价等指标,运用SPSS19.0软件进行数据统计学分析,检验水准均为α=0.05,以P0.05为有统计学意义。结果:全部47例患者均获得随访,随访时间24—27周,平均6个月。所有患者都得到较为满意的肩关节功能评分,无畸形愈合。其中手法整复小夹板固定组有1例出现张力性水泡,1例出现压疮,及时处理后治愈;锁定钢板内固定组无手术切口感染,无内固定失效发生。复位情况比较,锁定钢板组优于小夹板组(P0.05);骨折临床愈合时间比较,小夹板组优于锁定钢板组(P0.05);治疗后1个月肩关节功能评分比较,锁定钢板组优于小夹板组(P0.05);治疗后3个月,两组在肩关节功能评分方面无明显差异(P0.05);治疗后6个月,两组肩关节功能评价比较无明显差异(P0.05),其中小夹板组优良率为81.48%,锁定钢板组优良率为85%。结论:两组均有较好的临床治疗效果,肱骨近端锁定钢板内固定治疗在骨折复位、早期肩关节功能恢复方面优于手法整复小夹板固定,小夹板固定组在临床愈合时间上优于锁定钢板组,小夹板组虽然在治疗后1个月的肩关节功能评分方面差于锁定钢板组,但是治疗后3个月、6个月两组肩关节功能评分及治疗后6个月两组肩关节功能评价,均无明显差异。手法整复小夹板治疗由于创伤小,愈合时间短等优点,在通过合理的术后功能训练,配合中医药内外兼治,也可与手术切开治疗取得同样的治疗效果,疗效确切,值得临床应用推广。
[Abstract]:Objective: to compare the curative effect of manual reduction with small splint fixation and locking plate fixation in the treatment of humeral surgical neck fracture and to provide references for clinical treatment of proximal humerus fracture. Methods: from March 2014 to March 2016, 47 patients with humeral surgical neck fractures were retrospectively analyzed. According to the treatment plan, it was divided into manual reduction splint fixation group and proximal humerus locking plate fixation group. All patients were under the guidance of doctors and active functional exercise with Chinese medicine dialectical internal treatment and Chinese medicine fumigation treatment. The reduction status, clinical healing time, shoulder function score (Constant-Murley score) at 1 and 6 months after treatment and shoulder function evaluation at 6 months after treatment were observed and compared between the two groups. The data were statistically analyzed by SPSS19.0 software. The test level was 伪 = 0.05, with P0.05 as the statistical significance. Results: all 47 patients were followed up for 24-27 weeks (mean 6 months). All patients received a satisfactory shoulder function score without malunion. In the small splint fixation group, tension blisters were found in 1 case and pressure sores in 1 case, which were cured after timely treatment. There was no infection of operative incision and no failure of internal fixation in locking plate fixation group. Reduction, locking plate group is better than small splint group (P0.05), fracture clinical healing time, small splint group is better than locking plate group (P0.05); One month after treatment, the locking plate group was better than the small splint group (P0.05), and the two groups had no significant difference in the shoulder joint function score 3 months after treatment (P0.05). Six months after treatment, there was no significant difference in the evaluation of shoulder function between the two groups (P0.05). The excellent and good rate of the small splint group was 81.48 and the excellent and good rate of the locking plate group was 85.1%. Conclusion: both groups have good clinical effect. The treatment of proximal humerus locking plate internal fixation is superior to manual reduction of small splint fixation in fracture reduction and early recovery of shoulder joint function. The clinical healing time of small splint fixation group was better than that of locking plate group. Although the function score of shoulder joint in small splint group was worse than that in locking plate group one month after treatment, it was 3 months after treatment. There was no significant difference in the score of shoulder joint function between the two groups at 6 months and the evaluation of shoulder joint function in the two groups at 6 months after treatment. Because of the advantages of small splint reduction, such as small trauma and short healing time, through reasonable functional training after operation, combined with internal and external treatment of traditional Chinese medicine, the same therapeutic effect can also be obtained with surgical incision, and the curative effect is accurate. It is worthy of clinical application.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
本文编号：2327794
[Abstract]:Objective: to compare the curative effect of manual reduction with small splint fixation and locking plate fixation in the treatment of humeral surgical neck fracture and to provide references for clinical treatment of proximal humerus fracture. Methods: from March 2014 to March 2016, 47 patients with humeral surgical neck fractures were retrospectively analyzed. According to the treatment plan, it was divided into manual reduction splint fixation group and proximal humerus locking plate fixation group. All patients were under the guidance of doctors and active functional exercise with Chinese medicine dialectical internal treatment and Chinese medicine fumigation treatment. The reduction status, clinical healing time, shoulder function score (Constant-Murley score) at 1 and 6 months after treatment and shoulder function evaluation at 6 months after treatment were observed and compared between the two groups. The data were statistically analyzed by SPSS19.0 software. The test level was 伪 = 0.05, with P0.05 as the statistical significance. Results: all 47 patients were followed up for 24-27 weeks (mean 6 months). All patients received a satisfactory shoulder function score without malunion. In the small splint fixation group, tension blisters were found in 1 case and pressure sores in 1 case, which were cured after timely treatment. There was no infection of operative incision and no failure of internal fixation in locking plate fixation group. Reduction, locking plate group is better than small splint group (P0.05), fracture clinical healing time, small splint group is better than locking plate group (P0.05); One month after treatment, the locking plate group was better than the small splint group (P0.05), and the two groups had no significant difference in the shoulder joint function score 3 months after treatment (P0.05). Six months after treatment, there was no significant difference in the evaluation of shoulder function between the two groups (P0.05). The excellent and good rate of the small splint group was 81.48 and the excellent and good rate of the locking plate group was 85.1%. Conclusion: both groups have good clinical effect. The treatment of proximal humerus locking plate internal fixation is superior to manual reduction of small splint fixation in fracture reduction and early recovery of shoulder joint function. The clinical healing time of small splint fixation group was better than that of locking plate group. Although the function score of shoulder joint in small splint group was worse than that in locking plate group one month after treatment, it was 3 months after treatment. There was no significant difference in the score of shoulder joint function between the two groups at 6 months and the evaluation of shoulder joint function in the two groups at 6 months after treatment. Because of the advantages of small splint reduction, such as small trauma and short healing time, through reasonable functional training after operation, combined with internal and external treatment of traditional Chinese medicine, the same therapeutic effect can also be obtained with surgical incision, and the curative effect is accurate. It is worthy of clinical application.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
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