本文選題：肱骨遠端骨折 + C型��； 參考：《四川醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：本實驗期望通過前瞻性隨機對照研究證實肱骨遠端C型骨折術(shù)后即刻功能鍛煉與術(shù)后石膏制動1周后開始肘關(guān)節(jié)功能鍛煉對肘關(guān)節(jié)功能康復(fù)是否存在差異,并進一步證實術(shù)后不同體位制動1周對肘關(guān)節(jié)功能恢復(fù)是否存在差異。為肱骨遠端C型骨折的術(shù)后康復(fù)提供一條更全面、有效的方法。方法：本研究擬選擇2013年6月至2014年7月期間四川省人民醫(yī)院骨科以及雙流縣第一人民醫(yī)院骨科共90例肱骨遠端C型骨折手術(shù)病人,并隨機分為3組。A組：術(shù)后即刻開始肘關(guān)節(jié)功能鍛煉。30例,其中男16例,女14例,平均年齡38.4+13.26歲。AO分型：C1型8例,C2型16例,C3型6例。手術(shù)時間：傷后1-3天手術(shù)者：2例,傷后4-7天手術(shù)者：26例,傷后8-14天手術(shù)者：2例：B組：術(shù)后石膏外固定于屈肘90。位制動1周后開始肘關(guān)節(jié)功能鍛煉。30例,其中男19例,女11例,平均年齡39.43+13.27歲。AO分型：C1型9例,C2型15例,C3型6例。手術(shù)時間：傷后1-3天手術(shù)者：1例,傷后4-7天手術(shù)者：27例,傷后8-14天手術(shù)者：2例；C組：術(shù)后石膏外固定于屈肘30。位制動1周后開始肘關(guān)節(jié)功能鍛煉。30例,其中男17例,女13例,平均年齡40.97-+11.87歲。AO分型：C1型10例,C2型15例,C3型5例。手術(shù)時間：傷后1-3天手術(shù)者：2例,傷后4-7天手術(shù)者：27例,傷后8-14天手術(shù)者：1例。觀察患者的疼痛情況,肘關(guān)節(jié)活動度等功能情況,選用Mayo肘關(guān)節(jié)功能評分系統(tǒng)進行評定三組患者肘關(guān)節(jié)總體功能恢復(fù)情況,選用疼痛視覺類比評分(VAS)評定患者的疼痛程度,采用量角器測量患者肘關(guān)節(jié)屈伸以及前臂旋轉(zhuǎn)活動范圍。結(jié)果：術(shù)后90例患者均獲得隨訪,隨訪時間6月-21月。A組30例患者中術(shù)后平均8-12周達臨床愈合,所有切口均一期愈合,其中2例發(fā)生肘部骨化性肌炎表現(xiàn),2例創(chuàng)傷性關(guān)節(jié)炎,1例傷口紅腫,對癥治療后傷口紅腫好轉(zhuǎn)。B組30例患者中術(shù)后平均7-12周達臨床愈合,所有切口均一期愈合,其中3例發(fā)生肘部骨化性肌炎表現(xiàn),1例傷口紅腫,對癥治療后傷口紅腫好轉(zhuǎn)。C組30例患者中術(shù)后平均9-12周達臨床愈合,所有切口均一期愈合,其中3例發(fā)生肘部骨化性肌炎表現(xiàn)。結(jié)論：肱骨遠端C型骨折術(shù)后肘關(guān)節(jié)短期制動后再與功能鍛煉,雖然術(shù)后2周疼痛較即刻功能鍛煉者明顯,但術(shù)后6月在肘關(guān)節(jié)Mayo評分、疼痛視覺評分(VAS)、肘關(guān)節(jié)屈伸活動等方面在一定程度上優(yōu)于即刻功能鍛煉者。肱骨遠端C型骨折術(shù)后肘關(guān)節(jié)短期制動與即刻功能鍛煉者在影響前臂旋轉(zhuǎn)功能上無明顯差別。肱骨遠端C型骨折術(shù)后屈肘90度短期制動與屈肘30度短期制動,術(shù)后6月,在肘關(guān)節(jié)Mayo評分、疼痛視覺評分(VAS)、肘關(guān)節(jié)屈伸活動度、前臂旋轉(zhuǎn)活動度等方面無明顯差別。肱骨遠端C型骨折術(shù)后CPM機早期介入,循序漸進的增強主動、被動功能鍛煉可以促進患肢的靜脈回流,減輕腫脹,防止靜脈血栓形成,提高肌力以及關(guān)節(jié)活動度,減輕周圍組織粘連,改善關(guān)節(jié)功能狀態(tài)。肱骨遠端C型骨折術(shù)中結(jié)合使用兩枚非平行鋼板以及螺釘、克氏針可以有效的固定骨折塊,增加骨折穩(wěn)定性,有利于早期的功能鍛煉。肱骨遠端C型骨折術(shù)后功能鍛煉需要在臨床醫(yī)生的指導(dǎo)下,循序漸進,術(shù)后短期制動有利于減輕水腫,減少創(chuàng)口出血、局部腫脹、疼痛等,有利于患者肘關(guān)節(jié)功能恢復(fù)。
[Abstract]:Objective: the purpose of this study is to verify whether there is a difference in elbow function rehabilitation between the elbow joint functional exercise after 1 weeks after 1 weeks after the operation of the distal humeral fracture and after 1 weeks after the operation, and further confirms whether there is a difference between the 1 weeks after the operation for the recovery of the function of the elbow joint. The postoperative rehabilitation of type C fracture of the distal humerus provides a more comprehensive and effective method. Methods: This study was to choose 90 patients with C fracture of distal humerus in Department of orthopedics, Sichuan Provincial People's Hospital and the first people's Hospital in Shuangliu County from June 2013 to July 2014, and randomly divided into 3 groups of.A groups: the elbow joint work was started immediately after the operation. We can exercise.30 cases, including 16 males and 14 females, and the average age 38.4+13.26 years.AO classification: C1 type 8 cases, C2 type 16 cases, and C3 type 6 cases. The operation time: 2 cases and 4-7 days after injury: 26 cases, 8-14 days after injury: B group: Gypsum external fixation is fixed at elbow 90. position after 1 weeks and starts elbow joint functional exercise.3 0 cases, of which 19 were male and 11 women, the average age of.AO was 39.43+13.27 years old: 9 cases of type C1, 15 cases of C2 type, and 6 cases of C3 type. The operation time: 1 cases, 27 cases, 27 cases, 27 cases, 4-7 days after injury, 2 cases, and C group: the postoperative.30 cases of elbow joint function exercise started after the operation of gypsum outside the elbow flexion 30...30 cases of elbow joint function exercise began after the operation. There were 17 males and 13 females with the average age of 40.97-+11.87 years.AO classification: 10 cases of C1 type, 15 cases of type C2, 5 cases of C3 type. The operation time: 2 cases and 4-7 days after injury: 27 cases, 8-14 days after injury: 1 cases. The function of the pain and elbow joint activity of the patients were observed and the Mayo elbow joint function scoring system was selected. The total function recovery of the three groups of the three groups was evaluated. The pain degree of the patients was assessed by the visual analogue score (VAS). The protractor was used to measure the elbow flexion and extension of the patients and the range of the forearm rotation. Results: 90 patients were followed up after the operation, and the average follow-up time was 8-12 Zhou Dalin in the group of 30 patients in the group of 30 -21 months of June. There were 2 cases of ossifying myositis in the elbows, 2 cases of traumatic arthritis, 1 cases of red and swollen wound, 1 cases of wound redness and swelling after treatment, 30 patients in group.B were healed on average 7-12 weeks after operation, all incisions healed in one period, 3 cases of elbows with ossifying myositis, 1 cases of red and swollen wounds. The wound redness and swelling after symptomatic treatment improved in group.C, the average 9-12 weeks after operation in group.C was healed on average, all incisions healed in one stage, of which 3 cases had elbital ossifying myositis. Conclusion: after the distal C fracture of the humerus, the elbow joint was again after the short-term braking and functional exercise, although the pain was more obvious after 2 weeks after the operation than the immediate functional exercise. In June, the Mayo score of the elbow joint, the pain visual score (VAS), the flexion and extension of the elbow are better than the immediate functional exercise. There is no obvious difference between the short-term braking of the elbow joint and the immediate functional exercise after the operation of the distal humerus type fracture and the immediate function of the forearm. The 90 degree of elbow flexion after the distal humerus C fracture There was no significant difference in the Mayo score of elbow joint Mayo, visual score of pain (VAS), flexion and extension activity of elbow joint and the rotation of forearm in June after operation. There was no significant difference between the elbow joint flexion and extension activity and the forearm rotation activity in June. The early intervention of the CPM machine after the operation of the distal humerus type C fracture was progressively enhanced, and the dynamic exercise could promote the venous return of the affected limbs and reduce the swelling. To prevent venous thrombosis, improve muscle strength and joint activity, reduce surrounding tissue adhesion and improve joint function state. Combined use of two non parallel plates and screws, Kirschner pin can effectively fix fracture blocks, increase fracture stability and facilitate early functional exercise. C type fracture distal to the humerus in the distal humerus C fracture. The postoperative functional exercise needs to be step-by-step under the guidance of the clinician. Short-term postoperative braking is beneficial to reduce edema, reduce wound bleeding, local swelling, pain and so on, which is beneficial to the recovery of the elbow joint function.
【學(xué)位授予單位】：四川醫(yī)科大學(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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