【摘要】：目的：通過對所查閱的44份文獻(xiàn)報道的共940例浮肩病例以及臨床收集的12份病例進(jìn)行系統(tǒng)的分析,進(jìn)一步明確浮肩損傷的發(fā)病特點(diǎn)、致傷原因、骨折部位差異、診斷要點(diǎn)、合并傷、治療方法的選擇及并發(fā)癥的防治情況,評估兩種常見浮肩損傷類型的手術(shù)療效。方法：回顧性研究44份文獻(xiàn)報道的共940例浮肩病例,對病例的平均年齡、性別比例、致傷因素、受傷部位、骨折分型、合并傷、治療方法、術(shù)后并發(fā)癥、療效判定這些方面進(jìn)行系統(tǒng)分析。自2014年05月至2015年10月,于江蘇省中醫(yī)院及揚(yáng)州市中醫(yī)院收集浮肩損傷病例共12例,其中同側(cè)肩胛骨骨折伴肩鎖關(guān)節(jié)脫位有6例為A組,同側(cè)肩胛骨骨折伴鎖骨骨折有6例為B組,治療以手術(shù)治療為主,且均為鎖骨或肩鎖關(guān)節(jié)及肩胛骨同時固定,配合中醫(yī)治療,術(shù)前口服復(fù)元活血湯(柴胡15g,瓜蔞根10g,當(dāng)歸10g,川芎10g,赤芍10g,元胡6g,紅花6g,血竭6g,炮山甲6g,大黃1Og,桃仁15g,甘草6g),術(shù)后予以正規(guī)康復(fù)治療,包括中藥內(nèi)治、中藥熏洗及功法鍛煉,觀察其術(shù)后并發(fā)癥,并采用Constant-Murley肩關(guān)節(jié)功能評分及Herscvici評價標(biāo)準(zhǔn)進(jìn)行療效評價。結(jié)果：術(shù)后隨訪時間為12個月,所有患者全部愈合,肩關(guān)節(jié)功能恢復(fù)良好。根據(jù)Herscvici療效評價標(biāo)準(zhǔn),其中同側(cè)肩胛骨骨折伴鎖骨骨折的患者：優(yōu)4例,良1例,可1例,差0例。總的優(yōu)良率為100%。同側(cè)肩胛骨骨折伴肩鎖關(guān)節(jié)脫位的患者：優(yōu)3例,良2例,可1例,差0例。術(shù)后出現(xiàn)三角肌肌力減弱2例,未出現(xiàn)感染、關(guān)節(jié)僵硬、骨折延遲愈合、骨折不愈合、內(nèi)固定斷裂或移位等并發(fā)癥。收集的臨床病例在發(fā)病年齡、性別比例、致傷原因、發(fā)病部位與文獻(xiàn)報道有一定相關(guān)性。結(jié)論：同側(cè)肩胛骨骨折分別伴肩鎖關(guān)節(jié)脫位或鎖骨骨折時,采用聯(lián)合固定的手術(shù)方式,輔以中醫(yī)康復(fù)治療后,療效令人滿意,且無明顯術(shù)后并發(fā)癥。但由于樣本量小,尚不能與文獻(xiàn)研究的結(jié)果進(jìn)行全面充分的比較,無法通過統(tǒng)計學(xué)的方式明確哪種治療方法最適合于浮肩損傷的骨折,也無法明確患者的年齡、性別、致傷原因、骨折分型、合并傷及采用不同內(nèi)外固定方法等方面與肩關(guān)節(jié)功能恢復(fù)的關(guān)聯(lián)。
[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.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R274.9

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