【摘要】：目的：通過觀察比較肱骨近端骨折伴肩關(guān)節(jié)脫位的患者經(jīng)兩種不同治療方法后骨折復(fù)位情況、肩關(guān)節(jié)功能評(píng)分、骨折愈合時(shí)間等指標(biāo),探討過肩牽引拔伸法治療肩關(guān)節(jié)脫位合并肱骨近端骨折的臨床療效,為肱骨近端骨折伴肩關(guān)節(jié)脫位的非手術(shù)治療提供參考證據(jù)。方法：通過收集2014年8月至2015年8月期間收入蘇州市中醫(yī)院的住院及門急診治療的肱骨近端骨折伴肩關(guān)節(jié)脫位病例。將符合納入標(biāo)準(zhǔn)的23例按照治療方法分為手法復(fù)位夾板外固定組(試驗(yàn)組)和切開復(fù)位內(nèi)固定組(對(duì)照組)。術(shù)后隨訪6個(gè)月,觀察記錄兩組患者治療后骨折復(fù)位情況、肩關(guān)節(jié)功能評(píng)分、骨折愈合時(shí)間,利用統(tǒng)計(jì)學(xué)分析,比較組間療效。結(jié)果：1.治療2周后骨折復(fù)位情況比較,試驗(yàn)組優(yōu)良率為41.67%,對(duì)照組優(yōu)良率為81.81%,兩組數(shù)據(jù)經(jīng)非參數(shù)秩和檢驗(yàn),,差別具有統(tǒng)計(jì)學(xué)意義(P=0.020.05)。2.治療6個(gè)月后,試驗(yàn)組疼痛評(píng)分為10.16±1.34分,對(duì)照組疼痛評(píng)分為9.00+0.77分,兩組數(shù)據(jù)經(jīng)獨(dú)立樣本t檢驗(yàn),差別具有統(tǒng)計(jì)學(xué)意義(P=0.020.05)。3.治療6個(gè)月后,試驗(yàn)組日常功能活動(dòng)評(píng)分為12.75±1.06分,對(duì)照組為11.64±0.92分,兩組數(shù)據(jù)經(jīng)獨(dú)立樣本t檢驗(yàn),差別具有統(tǒng)計(jì)學(xué)意義(P=0.010.05)。4.治療6個(gè)月后,試驗(yàn)組肌力評(píng)分為17.17±0.94分,對(duì)照組為18.82±0.75分,兩組數(shù)據(jù)經(jīng)獨(dú)立樣本t檢驗(yàn),差別具有統(tǒng)計(jì)學(xué)意義(P=0.000.05)。5.試驗(yàn)組骨折臨床愈合時(shí)間為5.67±0.83周,對(duì)照組骨折臨床愈合時(shí)間為6.59±0.94周,兩組數(shù)據(jù)經(jīng)獨(dú)立樣本t檢驗(yàn),差別具有統(tǒng)計(jì)學(xué)意義(P=0.020.05)。結(jié)論：對(duì)于肱骨近端骨折伴肩關(guān)節(jié)脫位,采用過肩拔伸牽引、夾板外固定、功能鍛煉治療,在骨折臨床愈合時(shí)間及治療6個(gè)月時(shí)日常生活改善方面優(yōu)于切開復(fù)位內(nèi)固定組,值得在臨床上推廣使用。
[Abstract]:Objective: To study the clinical effect of shoulder-shoulder traction and pull-out method in the treatment of the fracture of the proximal humerus in the patients with the proximal humeral fracture with shoulder dislocation after two different treatment methods, such as the reduction of the fracture, the function of the shoulder joint and the time of fracture healing. Reference evidence was provided for non-operative treatment of proximal humeral fractures with dislocation of the shoulder. Methods: The proximal humeral fractures with the dislocation of the shoulder joint were collected from August 2014 to August 2015 in the hospital in Suzhou. The 23 patients who met the inclusion criteria were divided into the external fixation group (trial group) and the open reduction internal fixation group (control group) according to the treatment method. The patients were followed up for 6 months, and the reduction of the fracture, the function of the shoulder joint and the healing time of the fracture were recorded and the curative effect was compared between the two groups. Results:1. The excellent and good rate was 41.67% in the test group and 81.81% in the control group, and the difference between the two groups was statistically significant (P = 0.020.05). After 6 months of treatment, the pain scores of the test group were 10.16 and 1.34 points, and the pain scores of the control group were 9.00 + 0.77 points, and the two groups of data were tested by the independent samples t, and the difference was statistically significant (P = 0.020.05). After 6 months of treatment, the daily functional activity of the test group was 12.75-1.06, the control group was 11.64-0.92, and the two groups of data were tested by independent samples t, and the difference was statistically significant (P = 0.010.05). After 6 months of treatment, the muscle strength of the test group was 17.17-0.94, the control group was 18.82-0.75, the two groups of data were tested by independent samples t, and the difference was statistically significant (P = 0.0005). The clinical healing time of the test group was 5.67 and 0.83 weeks, and the clinical healing time of the control group was 6.59 to 0.94 weeks, and the two groups of data were tested by the independent samples t, and the difference was of statistical significance (P = 0.020.05). Conclusion: For the proximal humeral fracture with the dislocation of the shoulder joint, it is better than the internal fixation group to improve the daily life in the time of clinical healing of the fracture and the improvement of the daily life at 6 months, and it is worth to be popularized and used clinically.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R244.1

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