浮肩损伤的临床研究—12例临床观察

发布时间：2018-12-13 00:30

【摘要】：目的：通过对所查阅的44份文献报道的共940例浮肩病例以及临床收集的12份病例进行系统的分析,进一步明确浮肩损伤的发病特点、致伤原因、骨折部位差异、诊断要点、合并伤、治疗方法的选择及并发症的防治情况,评估两种常见浮肩损伤类型的手术疗效。方法：回顾性研究44份文献报道的共940例浮肩病例,对病例的平均年龄、性别比例、致伤因素、受伤部位、骨折分型、合并伤、治疗方法、术后并发症、疗效判定这些方面进行系统分析。自2014年05月至2015年10月,于江苏省中医院及扬州市中医院收集浮肩损伤病例共12例,其中同侧肩胛骨骨折伴肩锁关节脱位有6例为A组,同侧肩胛骨骨折伴锁骨骨折有6例为B组,治疗以手术治疗为主,且均为锁骨或肩锁关节及肩胛骨同时固定,配合中医治疗,术前口服复元活血汤(柴胡15g,瓜蒌根10g,当归10g,川芎10g,赤芍10g,元胡6g,红花6g,血竭6g,炮山甲6g,大黄1Og,桃仁15g,甘草6g),术后予以正规康复治疗,包括中药内治、中药熏洗及功法锻炼,观察其术后并发症,并采用Constant-Murley肩关节功能评分及Herscvici评价标准进行疗效评价。结果：术后随访时间为12个月,所有患者全部愈合,肩关节功能恢复良好。根据Herscvici疗效评价标准,其中同侧肩胛骨骨折伴锁骨骨折的患者：优4例,良1例,可1例,差0例。总的优良率为100%。同侧肩胛骨骨折伴肩锁关节脱位的患者：优3例,良2例,可1例,差0例。术后出现三角肌肌力减弱2例,未出现感染、关节僵硬、骨折延迟愈合、骨折不愈合、内固定断裂或移位等并发症。收集的临床病例在发病年龄、性别比例、致伤原因、发病部位与文献报道有一定相关性。结论：同侧肩胛骨骨折分别伴肩锁关节脱位或锁骨骨折时,采用联合固定的手术方式,辅以中医康复治疗后,疗效令人满意,且无明显术后并发症。但由于样本量小,尚不能与文献研究的结果进行全面充分的比较,无法通过统计学的方式明确哪种治疗方法最适合于浮肩损伤的骨折,也无法明确患者的年龄、性别、致伤原因、骨折分型、合并伤及采用不同内外固定方法等方面与肩关节功能恢复的关联。
[Abstract]:Objective: to make a systematic analysis of 940 floating shoulder cases and 12 clinical cases of floating shoulder injuries reported in 44 references, and to further clarify the characteristics of floating shoulder injuries, the causes of injuries, the differences of fracture sites, and the main points of diagnosis. Combined injury, choice of treatment methods and prevention and treatment of complications, to evaluate the surgical efficacy of two common types of floating shoulder injury. Methods: a total of 940 cases of floating shoulder were studied retrospectively. The average age, sex ratio, injury factors, injury location, fracture classification, combined injury, treatment methods, postoperative complications were analyzed. These aspects were analyzed systematically. From May 2014 to October 2015, 12 cases of floating shoulder injuries were collected from Jiangsu Provincial Hospital of Chinese Medicine and Yangzhou Hospital of Chinese Medicine, including 6 cases of ipsilateral scapular fracture with acromioclavicular dislocation. Six cases of ipsilateral scapular fracture associated with clavicular fracture were treated with surgical treatment, and all of them were fixed simultaneously with clavicle or acromioclavicular joint and scapular bone, combined with traditional Chinese medicine treatment. Before operation, Fuyuan Huoxue decoction (15g of Bupleurum, 10g of Trichosanthes, 10g of trichosanthes) was taken orally before operation. Angelica sinensis 10g, Chuanxiong 10g, Radix Paeoniae lanceolata 10g, Yuan Hu 6g, safflower 6g, blood 6g, Guanshanjia 6g, rhubarb 1Og, peach kernel 15g, licorice 6g), regular rehabilitation treatment was given after operation, including internal treatment of traditional Chinese medicine, fumigation and washing of traditional Chinese medicine and functional exercise. Postoperative complications were observed, and Constant-Murley shoulder function score and Herscvici evaluation criteria were used to evaluate the curative effect. Results: the follow-up time was 12 months. All the patients healed and the shoulder function recovered well. According to Herscvici criteria, 4 cases of ipsilateral scapular fracture with clavicle fracture were excellent, 1 case was good, 1 case was fair, and 0 case was poor. The total excellent and good rate is 100. The patients with ipsilateral scapular fracture and acromioclavicular dislocation were excellent in 3 cases, good in 2 cases, fair in 1 case and poor in 0 cases. There were 2 cases of deltoid muscle weakness, no infection, joint stiffness, delayed union of fracture, nonunion of fracture, fracture or displacement of internal fixation and so on. The age, sex ratio, cause of injury and location of the clinical cases were related to the literature reports. Conclusion: in the case of ipsilateral scapular fracture associated with acromioclavicular joint dislocation or clavicular fracture, the operative method of combined fixation and rehabilitation with traditional Chinese medicine is satisfactory, and there are no obvious postoperative complications. However, because of the small sample size, it is not possible to compare the results of the literature study completely and fully, and it is impossible to determine by statistical means which treatment is the most suitable for the fracture of floating shoulder injury, nor to determine the age and sex of the patient. The causes of injury, fracture classification, combined injury and different internal and external fixation were associated with functional recovery of shoulder joint.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

【相似文献】