中国修复重建外科杂志

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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

李海波 1 , 王跃 2 , 车峥 1 , 苟永胜 1 , , 徐琳 1 , 卢冰 2

1. 成都市双流区第一人民医院骨科（成都 610200） ;
2. 四川省医学科学院·四川省人民医院骨科（成都   610072）

收稿日期: 2017-01-04;  修回日期:2017-06-24; 

基金项目: 成都市卫生局科学研究基金重大攻关项目课题（2013023）

通讯作者: 苟永胜, Email: 15002828117@163.com

Effect of functional exercise at different time and different immobilization positions on functional recovery of elbow joint with type C distal humeral fractures

LI Haibo 1 , WANG Yue 2 , CHE Zheng 1 , GOU Yongsheng 1 , , XU Lin 1 , LU Bing 2

1. Department of Orthopaedics, the First People’s Hospital of Shuangliu District, Chengdu Sichuan, 610200, P.R.China ;
2. Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu Sichuan, 610072, P.R.China

Corresponding Author: GOU Yongsheng, Email: 15002828117@163.com

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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 humeralfractures. 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 that 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 the 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

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1. 陈明光. AO 可塑形双钢板置入内固定修复老年肱骨远端骨折: 效果的影响因素分析. 中国组织工程研究, 2015, 19(31): 5016-5020.
2. 刘士伟. 双侧锁定钢板内固定术治疗肱骨远端骨折临床分析. 河南外科学杂志, 2016, 22(2): 101-102.
3. 赵同生, 刘国庆, 杨烈东, 等. 肱骨远端骨折双钢板固定技术临床研究. 中国伤残医学, 2017, 25(5): 54-55.
4. 龚平, 刘平静. 双钢板内固定治疗成人肱骨远端骨折患者的疗效观察. 医疗装备, 2017, 30(6): 150-151.
5. 祁蓓, 胡兵. 肱骨远端骨折术后运动康复临床疗效观察. 深圳中西医结合杂志, 2017, 27(3): 90-91.
6. 谢刚泰. 肘关节骨折术后的早期康复治疗. 医药前沿, 2017, 7(7): 394.
7. 陈朝清. 早期运动康复对肘关节骨折后功能恢复的影响. 中国伤残医学, 2016, 24(14): 60-61.
8. 沈彦, 王朝阳, 吴兴旺, 等. 不同术式治疗成人 C 型肱骨远端骨折. 临床骨科杂志, 2015, 18(4): 504-505.
9. 孙铭. 经伸肌装置保护入路切开复位内固定治疗肱骨远端 C 型骨折的功能效果. 郑州大学学报(医学版), 2013, 48(5): 704-706.
10. 郭永智, 戴鹤玲, 赵建文, 等. 三种内固定技术治疗肱骨远端 C 型骨折的疗效比较. 中华创伤杂志, 2013, 29(5): 395-400.
11. 温干军, 江帝钦, 陈坚, 等. 三角固定技术治疗肱骨远端 AO-C 型骨折的临床疗效. 生物骨科材料与临床研究, 2017, 14(1): 46-50.
12. 高云, 张治宇. 两种术式治疗肱骨远端骨折远期效果观察. 临床军医杂志, 2017, 45(3): 292-294.
13. 龙安华, 韩大成, 胡国东, 等. 两种方法治疗成人肱骨远端骨折的回顾性队列研究. 北京医学, 2017, 39(2): 193-195.
14. 廖春雨. 肱骨远端 C 型骨折的治疗进展研究. 医学信息, 2017, 30(2): 30-31.
15. 万新河. 成人肱骨远端关节内骨折手术治疗体会. 医药前沿, 2017, 7(3): 171-172.
16. 付乐良, 吴志雄, 李青. 两种内固定方法治疗肱骨髁间 C 型骨折效果观察. 中外医学研究, 2017, 15(3): 145-147.
17. Montserrat-de la Paz S, García-Giménez MD, Ángel-Martín M, et al. Long-chain fatty alcohols from evening primrose oil inhibit the inflammatory response in murine peritoneal macrophages. J Ethnopharmacol, 2014, 151(1): 131-136.
18. Chen KH, Chiu HY, Lee JW, et al. Using the proximal perforator-based anterolateral thigh flap from the same donor site to salvage the reconstruction after failure of the distal perforator-based anterolateral thigh flap. Microsurgery, 2014, 34(5): 409-412.
19. Park M S, Yoon S J, Choi S M. Arthroscopic reduction and internal fixation of femoral head fractures[J]. J Orthop Trauma, 2014, 28(7): e164-168.
20. 廖亮华, 江兴妹, 叶志卫, 等. 早期康复对肘关节骨折术后功能恢复的影响. 中国康复理论与实践, 2010, 16(9): 867-869.
21. Unsworth-White J, Koka R, Churchill M, et al. The non-operative management of radial head fractures: a randomized trial of three treatments. Injury, 1994, 25(3): 165-167.