改良肩关节松动术对骨折后肩关节功能障碍的干预效应

Interventional effect of improved mobilization on dysfunction of fractured shoulder joint

目的:骨折后肩关节功能障碍的传统干预措施为运动疗法结合理疗及中医推拿手法,探讨肩关节松动技术增加到治疗方案中对肩关节功能障碍患者的干预效应。方法:选择2003-01/2004-12南京医科大学第一附属医院康复医学科收治的肩关节功能障碍患者90例,随机分为两组,对照组和关节松动术组各45例。对照组患者先行理疗,再行运动疗法,运动疗法总的治疗时间为每天1h左右,结束后以中医推拿手法结束治疗。10d为1个疗程,共进行3个疗程,各疗程间无间隔。关节松动术组在以上治疗基础上增加肩关节松动技术,1.5～2.0h/d。盂肱关节包括:①分离牵引。②长轴牵引。③向头侧滑动。④前屈向足侧滑动。⑤外展向足侧滑动。⑥前后向滑动。⑦后向前滑动。⑧外展摆动。⑨侧方滑动。⑩水平内收摆动。11后前向转动。12内旋摆动。13外旋摆动。胸锁关节包括:①前后向滑动;②上下滑动。肩锁关节:后向前滑动。肩胛胸壁关节:松动肩胛骨。评定治疗前及治疗3个疗程后两组患者患肩前屈、后伸、内收、外展活动范围值。结果:90例患者全部进入结果分析。①患肩前屈、后伸、内收、外展活动范围:3个疗程后关节松动术组较对照组显著改善犤(113±18,39±7,36±6,118±15)度;(87±11,30±6,25±7,79±16)度,(t=3.01～5.17,P<0.01)犦。②两组患者治疗3个疗程后均较治疗前显著改善(t=3.75～7.96,P<0.01)。结论:肩关节松动术能显著改善肩关节运动功能,可能与其可以直接牵拉关节周围软组织,在短时间内分离粘连,保持软组织良好的弹性和伸展性,从而改善关节活动范围有关。

AIM： Sports therapy combined with physical therapy and manual massage is a conventional method for the treatment of shoulder joint dysfunction after fracture. We aimed to investigate the interventional effect of shoulder joint mobilization plus the above method on the dysfunction of shoulder joint.METHODS： Ninety patients with dysfunction of shoulder joint hospitalized in the Department of Rehabilitation Medicine, First Affiliated Hospital of Nanjing Medical University between January 2003 and December 2004 were randomly divided into mobilization group（n=45） and control group（n=45）. Patients in the control group received physical therapy firstly, then sports therapy about 1 hour per day, and finally manual massage. Ten days were as a course for a total of 3 courses uninterruptedly. Patients in the mobilization group received the therapy as in the control group added with shoulder joint mobilization 1.5 to 2.0 hours per day. Mobilization of glenohumeral joints included： ①separating distraction, ②long axis distraction,③slipping to head, ④slipping to feet during anteflexion, ⑤slipping to feet during abduction, ⑥slipping forwards to backwards, ⑦slipping backwards to forwards, ⑧swing during abduction, ⑨lateral slipping, ⑩swing horizontally when adduction, （11）turning backwards to forwards, （12）swing during internal rotation, （13）swing during external rotation; Mobilization of sternoclavicular joint included： ①slipping forwards and backwards, ②slipping up and down; Mobilization of acromioclavicular joint was slipping backwards to forwards. The range of motion（ROM） values of anteflexion, postextension, adduction and abduction in patients were assessed before treatment and 3 courses after treatment.RESULTS： All the 90 patients were analyzed in the result. ①The angles of ROM of anteflexion, post-extension, adduction and abduction after 3 courses of treatment were （113±18）°, （39±7）°, （36±6）°, （118±15）° respectively in the mobilization group, significantly improved as compared with the control group[（87±11）°（30±6）°, （25°7）°, （79±16）°1（t=3.01 to 5.17,P 〈 0.01）. ②The angles of ROM of anteflexion, post-extension, adduction and abduction in either group were ameliorated after mobilization as compared with before mobilization（t=3.75 to 7.96, P 〈 0.01）.CONCLUSION： Shoulder joint mobilization can obviously improve the motor function of shoulder joint, which may be involved in its function of dragging peripheral soft tissues of joints directly, separating adhesion in a short time and keeping the soft tissues elastic and extensible, and thus can improve the ROM of joints.