中西医结合夹板外固定减少肱骨干骨折再移位的临床观察  

Clinical Observation on the Treatment of Humeral Shaft Fracture Undergo Minimal Change In Angulation After Splint External Fixation by Traditional Chinese and Western Medicine

作　　者：张鹏 方敏 李来月 ZHANG Peng;FANG Min;LI Lai-Yue(Department of Trauma Orthopaedics,Tianjin Hospital,Tianjin(300211),China)

机构地区：[1]天津医科大学代谢病医院骨科,天津300074

出　　处：《中国中西医结合外科杂志》2020年第4期692-696,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

摘　　要：目的:观察肱骨干骨折复位后夹板外固定对骨折X线片的变化。方法:回顾性研究61例肱骨干骨折闭合复位小夹板外固定治疗的患者,治疗后立即行X光片检查,随访伤后3天、1周、3周、6周、3个月、6个月的情况,主要观察指标是肱骨干骨折在冠状和矢状面测量的角度,第二指标有VAS评分,末次随访的DASH、肘关节MEPI、肩关节Constant、SF-36评分,骨折愈合、医源性桡神经损伤情况。结果:夹板固定后即刻X线片的平均角度为内翻8°和前屈6°。末次随访,平均冠状面成角是10°和前屈7°。在整个治疗过程中骨折丢失角度平均正位片2°和矢状面1°(P>0.05),平均每天内翻和屈曲畸形约0.01°。VAS评分均较干预前4.5分到2.0分下降,有显著的统计学差异(P<0.05)。DASH平均10.5分,MEPI平均94.1分,Constant平均95.1分,SF-36平均88.3分,发现一例骨折不愈合,二期手术干预愈合(愈合率97.6%),无医源性桡神经麻痹。结论:对肱骨干骨折复位后夹板外固定,可及时调整维持骨折复位成果、缓解疼痛、早期康复训练,取得优良的功能结果和满意度。Objective To observe the changes of the X-ray films of the fractures after the reduction of the humeral shaft fracture.Methods A retrospective study of 61 patients with humeral shaft fractures who treated with closed reduction and splint external fixation was performed immediately after treatment.X-ray examination was performed immediately after treatment.Follow-up was 3 days,1 week,3 weeks,6 weeks,3 months and 6 days after injury.The main outcome were the angles of the humeral shaft fractures measured in the coronal and sagittal planes.The second outcome was the VAS score,the last follow-up of DASH,the elbow joint MEPI,the shoulder joint Constant,the SF-36 score,fracture healing and iatrogenic radial nerve palsies.Results The average angle of the X-ray film immediately after the splint was fixed 8 degrees inversion and 6 degrees in flexion.At the last follow-up,the average coronal angle was 10 degrees and 7 degrees procurvatum.The fracture loss angle averaged 2 degrees in AP and 1 degreesin sagittal plane throughout the treatment(P>0.05)and the average daily inversion and flexion deformity was about 0.01 degrees.The VAS scores were lower than the 4.5(before the intervention)to 2.0 points,which were significant statistical differences(P<0.05).Average outcome scores were DASH 10.5,MEPI 94.1,Constant 95.1,SF-3688.3 and one nonunion was found.The second-stage surgical intervention was healed(healing rate 97.6%),which without iatrogenic radialnerve palsies.Conclusion The splint fixation of the humeral shaft fracture after reduction can timely adjust the results of maintaining fracture reduction,relieve pain,get early rehabilitation training and obtain excellent functional results and satisfaction.

关 键 词：肱骨干骨折 闭合复位 小夹板外固定 早期康复 

分 类 号：R683.41[医药卫生—骨科学]