保守治疗与切开复位内固定治疗NeerⅢ型肱骨近端骨折的临床研究

发布时间：2018-01-03 10:40

本文关键词：保守治疗与切开复位内固定治疗NeerⅢ型肱骨近端骨折的临床研究　出处：《湖北中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:研究及讨论保守治疗与切开复位内固定手术治疗NeerⅢ型肱骨近端骨折的临床治疗效果。方法:本研究回顾性分析了2013年10月-2015年10月期间,湖北省中医院骨科收入治疗的97例临床诊断为"肱骨近端骨折"且符合录入研究标准的病例。依据所给予治疗方案的区别,分为两组:A组为手术治疗组,使用切开复位钢板内固定手术治疗;B组为保守治疗组,使用中医传统手法整复、超肩夹板固定以及中药伤科熏洗汤熏洗治疗。通过长海疼痛尺、肢体肿胀分级,比较两组患者经治疗后患侧肩部疼痛及肿胀的变化情况。通过Neer评分系统,对比两组治疗后肩关节功能恢复情况。采用SPSS21版软件分析。结果:1.两组治疗前、治疗后即刻、治疗后第1天、第5天、1周、4周长海疼痛尺评分情况比较:两组治疗前疼痛情况相比较,经过两独立样本t检验,P=0.9190.05,两组数据差异无统计学意义;两组治疗后即刻疼痛情况相比较,经过两独立样本t检验,P=0.0000.05,两组数据差异有统计学意义;两组治疗后第1天疼痛情况相比较,经过两独立样本t检验,P=0.0000.05,两组数据差异有统计学意义;两组治疗后第5天疼痛情况相比较,经过两独立样本t检验,P=0.0000.05,两组数据差异有统计学意义;两组治疗后第4周疼痛情况相比较,经过两独立样本t检验,P=0.8830.05,两组数据差异无统计学意义。2.两组治疗前、治疗后即刻、治疗后第1天、第5天、1周、4周患肢肿胀分级情况比较:两组治疗前肿胀程度情况相比较,经过两独立样本t检验,P=0.9540.05,两组数据差异无统计学意义;两组治疗后即刻肿胀程度情况相比较,经过两独立样本t检验,P=0.8650.05,两组数据差异无统计学意义;两组治疗后第1天肿胀程度情况相比较,经过两独立样本t检验,P=0.0000.05,两组数据差异有统计学意义;两组治疗后第5天肿胀程度情况相比较,经过两独立样本t检验,P=0.0000.05,两组数据差异有统计学意义;两组治疗后第4周肿胀程度情况相比较,经过两独立样本t检验,P=0.6780.05,两组数据差异无统计学意义。3.两组治疗后骨折复位情况比较:两组治疗后复查X线片,比较骨折复位情况,经过x2检验,P=0.0000.05,故两组数据在统计学上有差异。4.两组治疗后3天内、第4周、第12周、第24周患侧肩关节Neer评分情况:两组治疗后3天内患侧肩关节功能情况相比较,经过两独立样本t检验,P=0.2030.05,两组数据差异无统计学意义;两组治疗后4周患侧肩关节功能情况相比较,经过两独立样本t检验,P=0.0000.05,两组数据差异有统计学意义;两组治疗后12周患侧肩关节功能情况相比较,经过两独立样本t检验,P=0.0010.05,两组数据差异有统计学意义;两组治疗后第24周患侧肩关节功能情况相比较,经过两独立样本t检验,P=0.6330.05,两组数据差异无统计学意义。5.两组治疗后第24周患侧与健侧肩关节Neer评分情况:A组内,治疗后第24周健侧、患侧肩关节功能情况比较,通过配对t检验,P=0.6790.05,两组数据差异无统计学意义;B组内,治疗后第24周健侧、患侧肩关节功能情况比较,通过配对t检验,P=0.4180.05,两组数据差异无统计学意义;两组治疗后第24周健侧肩关节功能情况比较,通过经过两独立样本t检验,P=0.9860.05,两组数据差异无统计学意义;两组治疗后第24周患侧肩关节功能情况比较,通过经过两独立样本t检验,P=0.6330.05,两组数据差异无统计学意义。结论:采用中医保守治疗NeerⅢ型肱骨近端骨折,患者疼痛、肿胀症状缓解快,肩关节功能恢复良好,值得于临床工作中推广应用。
[Abstract]:Objective: To study and discuss the clinical curative effect of conservative treatment with open reduction and internal fixation for the treatment of Neer type III fractures of the proximal humerus. Methods: This study retrospectively analyzed during October 2013 -2015 October, the clinical diagnosis of 97 cases of the Department of orthopedics of Hubei Provincial Traditional Chinese Medical Hospital for treatment of income "fracture of the proximal humerus and comply with the standards of input cases. On the basis of the difference between treatment plan, divided into two groups: A treatment group for the operation, the use of open reduction and internal fixation surgery; B group for conservative treatment group, using traditional Chinese medicine manipulation, super shoulder splint and traditional Chinese medicine fumigation Decoction fumigation treatment of Department of traumatology. The Changhai pain ruler, limb swelling grade, compared two groups of patients after treatment changes ipsilateral shoulder pain and swelling. The Neer scoring system, the recovery of shoulder joint function were compared between the two groups after treatment. Using SPSS21 software analysis. Results: 1. the two groups before treatment, immediately after treatment, first days, fifth days after treatment, 1 weeks, 4 weeks of Changhai pain ruler score were compared between the two groups: pain before treatment compared by two independent samples t test, P=0.9190.05, no statistically significant differences between the two groups of data; immediate pain after treatment the comparison of the two groups, with two independent samples t test, P=0.0000.05, there were significant differences between the two groups of data; first days of pain were compared after the treatment in the two groups, with two independent samples t test, P=0.0000.05, there were significant differences between the two groups of data; Fifth days of pain were compared in two groups after treatment, after two independent sample t test, P=0.0000.05, there were significant differences between the two groups of data; fourth weeks of pain were compared after the treatment in the two groups, with two independent samples t test, P=0.8830.05, no statistically significant differences between the two groups of data of.2. of two groups before treatment, immediately after treatment, treatment First days after treatment, fifth days, 1 weeks, 4 weeks of limb swelling grade: the swelling degree of the two groups before treatment compared with two independent samples t test, P=0.9540.05, no statistically significant differences between the two groups of data; immediate swelling degree of the two groups after treatment compared with two independent samples t test, P=0.8650.05, no statistically significant differences between the two groups of data; first days of swelling compared the two groups after treatment, after two independent sample t test, P=0.0000.05, there were significant differences between the two groups of data; the two group fifth days after treatment the degree of swelling conditions compared by two independent samples t test, P=0.0000.05, a statistically significant differences between the two groups of data; fourth weeks of swelling after two groups of treatment compared with two independent samples t test, P=0.6780.05, compare the fracture between the two groups was not statistically significant.3. reduction after treatment in two groups: two treatment group After the comparison of X-ray, fracture reduction, through the test of X2, P=0.0000.05, the two sets of data in a statistically significant difference between 3 days and two.4. after treatment, fourth weeks, Twelfth weeks, twenty-fourth weeks of shoulder Neer score: ipsilateral shoulder function condition within 3 days after the treatment in the two groups after comparison, two independent samples t test, P=0.2030.05, no statistically significant differences between the two groups of data; 4 weeks of shoulder joint function after the treatment in the two groups compared by two independent samples t test, P=0.0000.05, there were significant differences between the two groups of data; 12 weeks of shoulder joint function after the treatment in the two groups after comparison, two independent samples t test, P=0.0010.05, there were significant differences between the two groups of data; twenty-fourth weeks of ipsilateral shoulder joint function were compared after the treatment in the two groups, with two independent samples t test, P=0.6330.05, data of the two groups the difference was statistically significant in two groups.5. Score after twenty-fourth weeks and the contralateral side of shoulder joint Neer: A group within twenty-fourth weeks after treatment compared with the contralateral, ipsilateral shoulder function, by the paired t test, P=0.6790.05, no statistically significant differences between the two groups of data; in the B group, twenty-fourth weeks after treatment of contralateral, ipsilateral shoulder joint function to compare, by paired t test, P=0.4180.05, no statistically significant differences between the two groups of data; two groups twenty-fourth weeks after treatment of contralateral shoulder function compared to the situation, through the two independent samples t test, P=0.9860.05, no statistically significant differences between the two groups of data comparison; twenty-fourth weeks of shoulder joint function after the treatment in the two groups after two, through independent sample t test, P=0.6330.05, no statistically significant differences between the two groups of data. Conclusion: the traditional Chinese medicine conservative treatment of Neer type III fractures of the proximal humerus, pain, swelling and relieve symptoms quickly, good recovery of shoulder joint function, worth in clinical work In the 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】：2016
【分类号】：R274.1

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