本文關(guān)鍵詞： A3 B1型肱骨近端骨折 橋接組合式內(nèi)固定系統(tǒng) 手法復(fù)位 超肩關(guān)節(jié)夾板　出處：《云南中醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 針對(duì)肱骨近端骨折在治療方法上存在的諸多爭(zhēng)議,本課題通過運(yùn)用橋接組合式內(nèi)固定系統(tǒng)(Bridge combined fixation system,BCFS)手術(shù)治療與手法復(fù)位超肩關(guān)節(jié)夾板固定保守治療肱骨近端骨折,對(duì)其臨床治療效果進(jìn)行對(duì)比,分析兩種治療方案存在的優(yōu)缺點(diǎn)及影響療效的各方面因素,從而為臨床治療肱骨近端骨折提供一種有效的治療方案,并為選擇治療方案提供一定的科學(xué)依據(jù)。方法： 本課題于2013年03月至2014年11月在昆明醫(yī)科大學(xué)附屬延安醫(yī)院及昆明市中醫(yī)院骨科,收集符合納入標(biāo)準(zhǔn)的肱骨近端骨折病例30例。按照隨機(jī)分配原則分為兩組,即A組(BCFS手術(shù)治療組)、B組(手法復(fù)位超肩關(guān)節(jié)夾板固定保守治療組)各15例,A組平均年齡58.27±8.413歲,B組平均年齡60.33±6.810歲。臨床隨訪6-11個(gè)月,平均隨訪7.94±1.524個(gè)月。觀察治療后骨折對(duì)位、骨痂生長(zhǎng)、肩關(guān)節(jié)功能恢復(fù)情況,并采用SPSS19.0統(tǒng)計(jì)學(xué)軟件統(tǒng)計(jì)分析各項(xiàng)數(shù)據(jù)。結(jié)果： 兩組在年齡、性別、受傷機(jī)制、骨折分型上無明顯差異。治療6月后通過Constant Murley肩關(guān)節(jié)功能評(píng)定,兩組在肩關(guān)節(jié)疼痛與屈曲上P0.05,無顯著性差異。兩組在肩關(guān)節(jié)日常生活受限,肩關(guān)節(jié)的外展、內(nèi)旋、外旋、拉力,肩關(guān)節(jié)活動(dòng)總分及肩關(guān)節(jié)功能評(píng)定總分上P0.05,A組優(yōu)于B組,有顯著性差異。A組在患肩與健肩的肩關(guān)節(jié)功能評(píng)定自身比較上P0.05,患肩與健肩無顯著性差異;B組在患肩與健肩的肩關(guān)節(jié)功能評(píng)定自身比較上P0.05,有顯著性差異,健肩明顯優(yōu)于患肩。通過骨痂生長(zhǎng)評(píng)判標(biāo)準(zhǔn),在骨痂生長(zhǎng)上,兩組治療1月和3月后P0.05,A組優(yōu)于B組,有顯著性差異;6月后P0.05,無顯著性差異。通過骨折復(fù)位優(yōu)良標(biāo)準(zhǔn),在骨折端對(duì)位上P0.05,A組優(yōu)于B組,有顯著性意義。結(jié)論： BCFS手術(shù)治療相對(duì)手法復(fù)位超肩關(guān)節(jié)夾板固定保守治療A3、B1型肱骨近端骨折,在肩關(guān)節(jié)功能恢復(fù)上更好,骨折的復(fù)位更為滿意,骨痂的生長(zhǎng)更快,臨床的療效更為顯著。
[Abstract]:Objective: to discuss the treatment of proximal humerus fracture. In this paper, bridge combined fixation system is used to bridge the internal fixation system. Treatment of proximal humeral fractures by BCFS was compared with that of manipulative reduction and fixation of superscapulohumeral splints. The advantages and disadvantages of the two treatment schemes and the factors affecting the curative effect were analyzed so as to provide an effective treatment for the proximal humeral fracture. Methods: from March 2013 to November 2014, this study was conducted in the Department of Orthopaedics, Yan'an Hospital, Kunming Medical University and Kunming traditional Chinese Medicine Hospital. Thirty patients with proximal humerus fractures who met the inclusion criteria were collected and divided into two groups according to the principle of random distribution: group A: BCFS surgical treatment group. The average age of group A was 58.27 鹵8.413 years. The average age of group B was 60.33 鹵6.810 years old. The clinical follow-up was 6-11 months and the average follow-up was 7.94 鹵1.524 months. The recovery of shoulder function was analyzed by SPSS19.0 statistical software. Results: the age, sex and injury mechanism of the two groups were analyzed. There was no significant difference in fracture classification. After treatment June, Constant Murley shoulder function evaluation, the two groups in shoulder pain and flexion P0.05. There was no significant difference between the two groups. Group A was superior to group B in terms of limited daily life of shoulder joint, shoulder abduction, internal rotation, external rotation, pull force, total score of shoulder joint activity and total score of shoulder joint function evaluation. There was significant difference. Group A had no significant difference in the self-evaluation of shoulder joint function between the affected shoulder and the healthy shoulder (P0.05), but there was no significant difference between the affected shoulder and the healthy shoulder. In group B, there was a significant difference in the evaluation of shoulder joint function between the affected shoulder and the healthy shoulder, and the healthy shoulder was superior to the affected shoulder, and the callus growth was evaluated according to the criteria of callus growth. After January and March, group A was better than group B in the treatment of P0.05A, and there was a significant difference between the two groups. After June, there was no significant difference between group A and group B. according to the fine standard of fracture reduction, group A was better than group B on the end of fracture. Conclusion: compared with manual reduction and superscapulohumeral splint fixation, BCFS is better in the treatment of proximal humerus fracture of type A _ (3) and B _ (1), which is better in the recovery of shoulder joint function. The reduction of fracture is more satisfactory, the callus grows faster, and the clinical effect is more remarkable.
【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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本文編號(hào)：1459649