中国修复重建外科杂志

中国修复重建外科杂志

肱骨远端 C 型骨折术后不同时期功能锻炼及不同制动体位对疗效影响的研究

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目的 探讨肱骨远端 C 型骨折双钢板内固定术后不同时间开始功能锻炼以及术后不同制动体位对肘关节功能恢复的影响。 方法 将 2013 年 6 月—2015 年 7 月收治并符合选择标准的 120 例肱骨远端 C 型骨折患者纳入研究,随机分为 3 组,每组 40 例。A 组:术后即刻开始功能锻炼;B、C 组:术后患肢分别于屈肘 90°位、伸肘 30°位石膏外固定制动 1 周后开始功能锻炼。3 组患者性别、年龄、骨折分型、骨折侧别、受伤至手术时间以及手术入路比较,差异均无统计学意义(P>0.05),具有可比性。 结果 术后 A、B 组各 1 例发生切口红肿,其余患者切口均Ⅰ期愈合。A 组 5 例、B 组 4 例、C 组 5 例出现肘部骨化性肌炎表现;A、B、C 组并发症发生率分别为 15.0%(6/40)、12.5%(5/40)、12.5%(5/40),组间比较差异无统计学意义(χ2=0.144,P=0.930)。术后 3 组患者均获随访,随访时间 6~25 个月,平均 9.8 个月。术后 2 周 A 组 Mayo 肘关节功能评分高于 B、C 组(P<0.05),疼痛视觉模拟评分显著低于 B、C 组(P<0.05);B、C 组间比较差异均无统计学意义(P>0.05)。术后 6 个月 3 组以上指标比较差异均无统计学意义(P>0.05)。术后 2 周及 6 个月时,A、C 组肘关节屈伸活动度优于 B 组(P<0.05),A、C 组间比较差异无统计学意义(P>0.05);而 3 组前臂旋转活动度比较差异无统计学意义(P>0.05)。3 组骨折均达临床愈合,愈合时间比较差异无统计学意义(P>0.05)。 结论 肱骨远端 C 型骨折术后即刻开始关节功能锻炼,可以缓解早期疼痛,获得较好肘关节屈伸功能;肘关节固定于伸肘30°位较屈肘 90°位,可更好地恢复肘关节屈伸活动度。

Objective To investigate the effect of functional exercises at different time and different immobilization positions on the functional recovery of elbow joint with type C distal humeral fractures. Methods A total of 120 patients with type C distal humeral fractures admitted to the hospital between June 2013 and July 2015 were included in the study. They were randomly allocated to 3 groups, 40 patients in each group. Group A: functional exercises began immediately after the operation; Group B: the affected elbow was fixed at 90° flexion for 1 week and then began functional exercises after 1 week of immobilization; Group C: the affected elbow was fixed at 30° extension for 1 week and then began functional exercises after 1 week of immobilization. There was no significant difference in gender, age, fracture pattern, fracture side, injury time, and surgical approach between groups (P>0.05). Results In groups A and B, 1 case had incision redness and swelling respectively, and the other incisions healed by first intention. Five patients occurred myositis ossificans in group A, 4 cases in group B, and 5 cases in group C. The incidence of complications in groups A, B, and C was 15.0% (6/40), 12.5% (5/40), and 12.5% (5/40), respectively. There was no significant difference between groups (χ2=0.144, P=0.930). All patients were followed up 6-25 months, with an average of 9.8 months. At 2 weeks after operation, the Mayo elbow joint function score of group A was significantly higher than those of groups B and C (P<0.05), and the visual analogue scale (VAS) of group A was significantly lower than those of groups B and C (P<0.05). There was no significant difference between groups B and C (P>0.05). At 6 months after operation, there was no significant difference in Mayo elbow joint function score and VAS score between groups (P>0.05). At 2 weeks and 6 months after operation, the flexion and extension activities of elbow joint in groups A and C were better than that in group B (P<0.05), and there was no significant difference between groups A and C (P>0.05). There was no significant difference in forearm rotation between groups (P>0.05). All fractures of 3 groups achieved clinical healing, and there was no significant difference in healing time between groups (P>0.05). Conclusion Early functional exercises can relieve pain and obtain better elbow flexion and extesion activities after operation. The elbow joint fixed at 30° extension is better than at 90° flexion in elbow flexion and extension activitis.

关键词: 肱骨远端骨折; 内固定; 功能锻炼; 关节制动

Key words: Distal humeral fracture; internal fixation; functional exercise; joint immobilization

引用本文: 李海波, 王跃, 车峥, 苟永胜, 徐琳, 卢冰. 肱骨远端 C 型骨折术后不同时期功能锻炼及不同制动体位对疗效影响的研究. 中国修复重建外科杂志, 2017, 31(8): 946-951. doi: 10.7507/1002-1892.201701021 复制

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