正骨手法治疗肱骨近端骨折合并肩关节脱位  

Treatment of proximal humerus fractures combined with shoulder dislocation using bone setting manipulation

作　　者：江涛 江林 史俊德 江永革 刘度量 

机构地区：[1]浏阳市骨伤科医院,湖南浏阳410327

出　　处：《中国骨伤》2018年第2期175-179,共5页China Journal of Orthopaedics and Traumatology

基　　金：湖南省中医药管理局科研计划项目(编号:2015172)~~

摘　　要：目的 :探讨正骨手法治疗肱骨近端骨折合并肩关节脱位的治疗技巧及其临床疗效。方法 :自2015年1月至2015年12月,采用正骨手法对118例肱骨近端骨折合并肩关节脱位进行复位,手法治疗后予以胶带或克氏针固定;男56例,女62例:年龄48~88岁,平均61岁;受伤至整复时间1~31 d,平均3 d;均为闭合性骨折,根据Neer标准分类:Ⅱ型27例,Ⅲ型55例,Ⅳ型36例;肩关节盂下脱位85例,喙突下脱位33例;所有患者伴有明显的肩关节部位畸形、功能障碍等症状;所有患者经X线肩关节正侧位摄片确诊,并在臂丛麻醉下行正骨手法复位。根据患者骨折类型及固定方式鼓励患者行患肢康复锻炼,参照Constant-Murley肩关节评分系统进行疗效判定。结果:全部病例获随访,时间6~12个月,平均9个月。术后出现肱骨头坏死1例,创伤性肩周炎2例,末次随访肩关节功能Constant-Murley评分为84.5±4.5,其中优78例,良28例,可9例,差3例,优良率89.8%。X线片显示所有病例骨性愈合。结论:采用正骨手法治疗肱骨近端骨折合并肩关节脱位,手法巧,手术操作简单,创伤小,疗效满意。Objective：To explore the treatment skill and clinical effect of bone setting manipulation in treating proximal humeral fracture with shoulder dislocation. Methods：From January 2015 to December 2015,118 cases of proximal humeral fractures with shoulder joint dislocation were treated by bone setting reduction and fixation with adhesive tape or Kirschner wire after reduction,including 56 males and 62 females with an average age of 61 years old ranging from 48 to 88 years old. The time from injury to treatment was 1 to 31 days with an average of 3 days. All fractures were closed,according to Neer standard classification,there were 27 cases of type Ⅱ,55 cases of type Ⅲ and 36 cases of type Ⅳ. There were 85 cases of shoulder subglenoid dislocation,33 cases of subcoracoid dislocation. All the patients were accompanied by obvious shoulder joint deformity,dysfunction and other symptoms. All cases were diagnosed by X-ray examination,and the bone setting manipulation was performed under the brachial plexus anesthesia. According to the type of fracture and fixation method,the patients were encouraged to exercise the limb rehabilitation,and the curative effect was determined by Constant-Murley shoulder score system. Results：All cases were followed up for 6 to 12 months with an average of 9 months. There were 1 case of humeral head necrosis,2 cases of traumatic frozen shoulder. The score of shoulder joint function Constant-Murley was 84.5±4.5; among them,78 cases were excellent,28 cases were good,9 cases were fair,3 cases were poor,the excellent and the good rate was 89.8%. X-ray showed bony union of all cases. Conclusion：The treatment of proximal humeral fracture with dislocation of shoulder joint by bone setting manipulation is a skillful method,with simple operation,small trauma and satisfactory curative effect.

关 键 词：肩关节 脱位 肱骨骨折 正骨手法 

分 类 号：R274.2[医药卫生—中医骨伤科学]