發(fā)布時間：2018-06-01 00:03

  本文選題：肩胛骨骨折 + 手術(shù)��； 參考：《山東中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的:對肩胛骨骨折的治療方法的選擇及臨床效果進(jìn)行分析與比較,進(jìn)而有效探討肩胛骨骨折的分型、診斷和具體治療方法,以實現(xiàn)不同類型肩胛骨骨折的最佳治療。資料與方法:回顧我院骨科在2004年1月-2014年4月收治的48例肩胛骨骨折患者。其中,男性33例,女性15例。依據(jù)Hardegger的骨折分型,對骨折進(jìn)行分類:體部骨折14例,肩胛頸骨折8例(解剖頸骨折3例,外科頸骨折5例),肩胛盂骨折11例(盂窩骨折5例,盂緣骨折6例),肩峰骨折3例,喙突骨折4例,肩胛岡骨折5例,粉碎性骨折3例。在這些骨折的治療中,采用非手術(shù)治療有32例,手術(shù)治療的有16例,其中非手術(shù)治療組中有10例具備手術(shù)指征但未行手術(shù)治療。因此我們將這48例患者分成三組,第一組為非手術(shù)組中移位較輕不具備手術(shù)指征的22例,第二組為非手術(shù)組中具備手術(shù)指征但未行手術(shù)治療的10例,第三組為手術(shù)組。其中穩(wěn)定的沒有移位或者移位輕微的骨折我們均采用非手術(shù)治療,對移位較大不穩(wěn)定性的肩胛骨骨折,我們10例(具備手術(shù)指征)采用非手術(shù)治療,16例采用手術(shù)治療。本文使用Hardegger功能評定方法對不同類型的肩胛骨骨折治療效果進(jìn)行評定,發(fā)現(xiàn)穩(wěn)定的沒有移位或者輕微移位的肩胛骨骨折經(jīng)過非手術(shù)治療優(yōu)良率較高,移位較大不穩(wěn)定性的肩胛骨骨折手術(shù)組優(yōu)良率明顯高于非手術(shù)組(10例具備手術(shù)指征但未行手術(shù)治療),同時手術(shù)組的并發(fā)癥發(fā)生率低于非手術(shù)組(10例具備手術(shù)指征但未行手術(shù)治療)。結(jié)果:隨訪手術(shù)組與非手術(shù)組的病例3-12個月,對每個患者的隨訪時間是26個周。通過治療,基本上所有的患者都愈合了,平均愈合時間是1.5-3個月。按照Hardegger功能評定原則,非手術(shù)治療第一組22例:優(yōu)20例、良1例、可1例、差0例。非手術(shù)治療第二組10例(具備手術(shù)指征但未行手術(shù)治療):優(yōu)1例、良2例、可2例、差5例。手術(shù)組16例:優(yōu)12例、良2例、可1例、差1例。從并發(fā)癥來看,第二組(具備手術(shù)指征但未行手術(shù)治療)的并發(fā)癥的發(fā)生率要顯著高于第一組和手術(shù)組的并發(fā)癥發(fā)生率。結(jié)論:在本研究中,穩(wěn)定的沒有移位或者移位輕微的肩胛骨骨折通過非手術(shù)治療能夠達(dá)到滿意的愈后效果,對于移位較大不穩(wěn)定性的肩胛骨骨折手術(shù)治療與非手術(shù)治療療效存在明顯差異,因此通常情況下穩(wěn)定的沒有移位或者移位輕微的肩胛骨骨折可以采用常規(guī)非手術(shù)治療,但對于移位較大不穩(wěn)定性的肩胛骨骨折的病例,運用手術(shù)治療能達(dá)到更好的臨床效果,而且并發(fā)癥也較少。在臨床中,可以根據(jù)骨折的部位、類型、移位情況決定治療方案。
[Abstract]:Objective: to analyze and compare the treatment methods and clinical effects of scapular fractures, and to explore effectively the classification, diagnosis and treatment of scapular fractures in order to achieve the best treatment of different types of scapular fractures. Materials and methods: 48 cases of scapular fractures treated in our department of orthopedics from January 2004 to April 2014 were reviewed. Among them, 33 cases were males and 15 cases were females. According to Hardegger's fracture classification, 14 cases of body fracture, 8 cases of scapular neck fracture (3 cases of anatomical neck fracture, 5 cases of surgical neck fracture), 11 cases of scapular pelvic fracture (5 cases of pelvic fossa fracture, 6 cases of glenoid margin fracture, 3 cases of acromion fracture) were classified. There were 4 cases of coracoid process fracture, 5 cases of scapular fracture and 3 cases of comminuted fracture. In the treatment of these fractures, 32 cases were treated with non-operative treatment, and 16 cases were treated surgically. In the group of non-operative treatment, 10 cases had the indication of operation but did not undergo surgical treatment. Therefore, we divided the 48 patients into three groups. The first group was 22 cases with light displacement and no indication of operation, the second group was 10 cases of non-operative group without surgical treatment, and the third group was operation group. Among them, the stable fractures with no displacement or slight displacement were all treated by non-surgical treatment. For the scapular fractures with greater instability, 10 of us (with surgical indications) were treated with non-surgical treatment in 16 cases. Hardegger functional evaluation method was used to evaluate the therapeutic effects of different types of scapular fractures. It was found that stable scapular fractures without or slightly displaced scapular fractures had a higher rate of excellent and good results after non-operative treatment. The excellent and good rate of scapular fracture with greater instability of displacement was significantly higher in the operative group than in the non-operative group. The incidence of complications in the operative group was lower than that in the non-operative group, and the incidence of complications in the operative group was lower than that in the non-operative group. But no surgical treatment was performed. Results: each patient was followed up for 26 weeks for 3-12 months in both operative and non-operative groups. After treatment, almost all patients healed, with an average healing time of 1. 5-3 months. According to the principle of Hardegger functional evaluation, 22 cases in the first group of non-operative treatment were excellent in 20 cases, good in 1 case, fair in 1 case, and poor in 0 cases. In the second group, there were 10 cases (1 excellent, 2 good, 2 fair and 5 poor) with the indication of operation but not with the surgical treatment, which were excellent in 1 case, good in 2 cases, fair in 2 cases and poor in 5 cases. In the operation group, 12 cases were excellent, 2 cases were good, 1 case was fair, and 1 case was poor. In terms of complications, the incidence of complications in the second group was significantly higher than that in the first group and the operative group. Conclusion: in this study, stable undisplaced or slightly displaced scapular fractures can achieve satisfactory results through non-surgical treatment. There was significant difference between operative treatment and non-operative treatment for scapular fractures with greater displacement instability. Therefore, in general, stable scapular fractures with no displacement or slight displacement can be treated with conventional non-surgical treatment. But for patients with scapular fractures with greater displacement instability, surgical treatment can achieve better clinical results and fewer complications. In clinic, the treatment plan can be determined according to the site, type and displacement of fracture.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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