【摘要】：目的:對(duì)比手法整復(fù)小夾板固定與鎖定鋼板內(nèi)固定治療肱骨外科頸骨折的療效,對(duì)臨床治療肱骨近端骨折提供參考資料。方法:回顧性分析湖北省中醫(yī)院骨科在2014年3月~2016年3月期間,根據(jù)納入標(biāo)準(zhǔn)、排除標(biāo)準(zhǔn),選取的47例肱骨外科頸骨折患者。依據(jù)治療方案不同分為手法整復(fù)小夾板固定組和肱骨近端鎖定鋼板內(nèi)固定組。所有患者均在醫(yī)師指導(dǎo)下積極功能鍛煉并配合中藥辯證內(nèi)治法及中藥熏洗治療。觀察并比較兩組復(fù)位情況,臨床愈合時(shí)間,治療后1、3、6個(gè)月肩關(guān)節(jié)功能評(píng)分(Constant-Murley評(píng)分)及治療后6個(gè)月肩關(guān)節(jié)功能評(píng)價(jià)等指標(biāo),運(yùn)用SPSS19.0軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)學(xué)分析,檢驗(yàn)水準(zhǔn)均為α=0.05,以P0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果:全部47例患者均獲得隨訪,隨訪時(shí)間24—27周,平均6個(gè)月。所有患者都得到較為滿意的肩關(guān)節(jié)功能評(píng)分,無畸形愈合。其中手法整復(fù)小夾板固定組有1例出現(xiàn)張力性水泡,1例出現(xiàn)壓瘡,及時(shí)處理后治愈;鎖定鋼板內(nèi)固定組無手術(shù)切口感染,無內(nèi)固定失效發(fā)生。復(fù)位情況比較,鎖定鋼板組優(yōu)于小夾板組(P0.05);骨折臨床愈合時(shí)間比較,小夾板組優(yōu)于鎖定鋼板組(P0.05);治療后1個(gè)月肩關(guān)節(jié)功能評(píng)分比較,鎖定鋼板組優(yōu)于小夾板組(P0.05);治療后3個(gè)月,兩組在肩關(guān)節(jié)功能評(píng)分方面無明顯差異(P0.05);治療后6個(gè)月,兩組肩關(guān)節(jié)功能評(píng)價(jià)比較無明顯差異(P0.05),其中小夾板組優(yōu)良率為81.48%,鎖定鋼板組優(yōu)良率為85%。結(jié)論:兩組均有較好的臨床治療效果,肱骨近端鎖定鋼板內(nèi)固定治療在骨折復(fù)位、早期肩關(guān)節(jié)功能恢復(fù)方面優(yōu)于手法整復(fù)小夾板固定,小夾板固定組在臨床愈合時(shí)間上優(yōu)于鎖定鋼板組,小夾板組雖然在治療后1個(gè)月的肩關(guān)節(jié)功能評(píng)分方面差于鎖定鋼板組,但是治療后3個(gè)月、6個(gè)月兩組肩關(guān)節(jié)功能評(píng)分及治療后6個(gè)月兩組肩關(guān)節(jié)功能評(píng)價(jià),均無明顯差異。手法整復(fù)小夾板治療由于創(chuàng)傷小,愈合時(shí)間短等優(yōu)點(diǎn),在通過合理的術(shù)后功能訓(xùn)練,配合中醫(yī)藥內(nèi)外兼治,也可與手術(shù)切開治療取得同樣的治療效果,療效確切,值得臨床應(yīng)用推廣。
[Abstract]:Objective: to compare the curative effect of manual reduction with small splint fixation and locking plate fixation in the treatment of humeral surgical neck fracture and to provide references for clinical treatment of proximal humerus fracture. Methods: from March 2014 to March 2016, 47 patients with humeral surgical neck fractures were retrospectively analyzed. According to the treatment plan, it was divided into manual reduction splint fixation group and proximal humerus locking plate fixation group. All patients were under the guidance of doctors and active functional exercise with Chinese medicine dialectical internal treatment and Chinese medicine fumigation treatment. The reduction status, clinical healing time, shoulder function score (Constant-Murley score) at 1 and 6 months after treatment and shoulder function evaluation at 6 months after treatment were observed and compared between the two groups. The data were statistically analyzed by SPSS19.0 software. The test level was 偽 = 0.05, with P0.05 as the statistical significance. Results: all 47 patients were followed up for 24-27 weeks (mean 6 months). All patients received a satisfactory shoulder function score without malunion. In the small splint fixation group, tension blisters were found in 1 case and pressure sores in 1 case, which were cured after timely treatment. There was no infection of operative incision and no failure of internal fixation in locking plate fixation group. Reduction, locking plate group is better than small splint group (P0.05), fracture clinical healing time, small splint group is better than locking plate group (P0.05); One month after treatment, the locking plate group was better than the small splint group (P0.05), and the two groups had no significant difference in the shoulder joint function score 3 months after treatment (P0.05). Six months after treatment, there was no significant difference in the evaluation of shoulder function between the two groups (P0.05). The excellent and good rate of the small splint group was 81.48 and the excellent and good rate of the locking plate group was 85.1%. Conclusion: both groups have good clinical effect. The treatment of proximal humerus locking plate internal fixation is superior to manual reduction of small splint fixation in fracture reduction and early recovery of shoulder joint function. The clinical healing time of small splint fixation group was better than that of locking plate group. Although the function score of shoulder joint in small splint group was worse than that in locking plate group one month after treatment, it was 3 months after treatment. There was no significant difference in the score of shoulder joint function between the two groups at 6 months and the evaluation of shoulder joint function in the two groups at 6 months after treatment. Because of the advantages of small splint reduction, such as small trauma and short healing time, through reasonable functional training after operation, combined with internal and external treatment of traditional Chinese medicine, the same therapeutic effect can also be obtained with surgical incision, and the curative effect is accurate. It is worthy of clinical application.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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