改良的肩胛骨控制训练对锁骨骨折术后肩胛骨功能的影响  

Effect of Improved Scapular Control Training on Scapular Function after Clavicle Fracture Surgery

作　　者：丁正美 黄宾 朱小建[1] 刘二涛 秦晓东 郭张建 曹建华[1] 陶永清[1] 冒维海 蒋云杰 黄辉 DING Zheng-mei;HUANG Bin;ZHU Xiao-jian(Department of orthopedics,the fourth People's hospital of Nantong,Nantong,Jiangsu 226005)

机构地区：[1]江苏省南通市第四人民医院,江苏南通226005

出　　处：《中国伤残医学》2023年第7期9-12,47,共5页Chinese Journal of Trauma and Disability Medicine

基　　金：2021年南通市卫健委科研项目(MB2020046)。

摘　　要：目的:采用改良的肩胛骨控制训练对患者早期康复,探讨该种训练方法是否对肩胛骨功能产生正性影响。方法:前瞻性病例对照研究。纳入我院骨科2019年1月-2021年6月收治的单侧锁骨中段骨折的患者30例,按照数字随机分组分为对照组15例和观察组15例,所有患者均接受骨折开放复位、双层锁定钢板螺钉内固定手术。对照组术后常规康复治疗。按时间节点依次由手腕肘关节逐步过渡到盂肱关节、全肩关节等,从被动到主动、小幅度到全关节范围的循序康复训练;观察组术后在常规康复的基础上增加肩胛骨控制训练。第1周即主动行耸肩、沉肩、含胸、扩胸等动作训练,共8周。术后3、6个月时采用DASH-Chinese评定上肢功能恢复情况;同时分别测定健、患侧肩关节的最大主动前屈、外展、后伸幅度,采用ROM评定肩关节功能。结果:术后3个月时所有骨折均达到临床愈合标准,内固定无松动、折断。2组患者上肢功能纵向比较,差异均有统计学意义(P值均<0.05),2组患者同时点的上肢功能横向比较,观察组好于对照组,差异有统计学意义(P值均<0.05);相同体位时,对照组和观察组的患侧ROM纵向比较,差异均有统计学意义(前屈、外展、后伸P值均<0.05)。相同体位、相同时点,2组患侧的ROM横向比较,观察组好于对照组,差异有统计学意义(前屈、外展、后伸的P值均<0.05)。不同康复治疗后,2组患者的患侧肩关节功能和上肢功能均改善,针对肩胛骨控制训练的观察组患者,其患侧肩关节功能和上肢功能明显好于同时段的对照组。结论:采用双层锁定钢板螺钉内固定治疗的锁骨中段骨折患者,早期通过耸肩、沉肩、含胸、扩胸等动作针对肩胛骨控制训练,能有效提升肩胛骨功能,能更好恢复肩关节功能。Objective:To explore whether the improved scapula control training has a positive effect on scapula function in early rehabilitation of patients.Method:A prospective case-control study.From January 2019 to June 2021,30 patients with unilateral middle clavicle fracture were included,including 23 males,7 females,15 left and 15 right,aged 27~61 years.They were randomly divided into control group and observation group.All patients underwent open reduction and double-layer locking plate and screw internal fixation.15 cases in the control group received routine rehabilitation treatment after operation(step by step from wrist and elbow joint to glenohumeral joint and total shoulder joint according to the time node,and sequential rehabilitation training from passive to active,small range to whole joint range);15 cases in the observation group received additional shoulder blade control training on the basis of routine rehabilitation after operation(shrugging,shoulder sinking,chest containing and chest expansion were actively performed in the first week,for a total of 8 weeks).The recovery of upper limb function was evaluated by DASH-Chinese at 3 and 6 months after operation.At the same time,the maximum active flexion,abduction and extension of the shoulder joint on the healthy side and the affected side were measured respectively,and the function of the shoulder joint was evaluated by ROM.Result:Three months after operation,all fractures met the clinical healing standard,and the internal fixation was not loose or broken.The longitudinal comparison of upper limb function between the two groups was statistically significant(P<0.05);the horizontal comparison of upper limb function at the same time point between the two groups showed that the observation group was better than the control group,and the difference was statistically significant.(P<0.05).In the same position,there was significant difference in thelongitudinal comparison of ROM on the affected side between the control group and the observation group(P<0.05 for fle

关 键 词：锁骨骨折 肩胛骨 肩胸关节 康复治疗 

分 类 号：R493[医药卫生—康复医学]