手法复位小夹板治疗肱骨近端3部分骨折的病例对照研究

Manipulative reduction and small splint fixation for treatment of three-part fractures of proximal humerus:a case-control study

目的:前瞻性研究肱骨近端3部分骨折的中医治疗疗效。方法:自2009年1月至2012年2月,采用两种方法治疗新鲜闭合性骨折肱骨近端3部分骨折118例。手术组:男22例,女37例;年龄45～83岁,平均(65.80±10.62)岁,病程(22.58±22.11)h,采用切开复位锁定钢板内固定手术治疗;手法组:男21例,女38例;年龄45～85岁,平均(65.98±11.10)岁,病程(20.85±22.63)h,采用手法复位、小夹板外固定的方法治疗。治疗后对患者肩关节的疼痛、功能、活动及解剖指标进行观察评估。结果:所有患者获随访,时间3～12个月,平均8.2个月。以Neer评分标准评价疗效:手术组术后评分(85.47±6.15)分,满意率88.20%;手法组术后评分(84.95±5.70)分,满意率86.40%;两组比较差异无统计学意义(P>0.05)。结论:手法组与手术组治疗肱骨近端3部分骨折均能达到满意效果,手法复位小夹板固定可以规避手术风险,减少局部血运破坏,既保证了疗效又减少治疗费用,是治疗肱骨近端3部分骨折的良好方法。

Objective：To study Chinese medicine treatment in the three-part of the proximal humerus fractures. Meth- ods： From January 2009 to February 2012,118 cases of proximal humerus three-part fractures were used two methods of operation and manipulation treatment, that were all acute and closed. In operation group：there were 22 males and 37 females ,the mean age of the patients was （65.80±10.62） years （ranged from 45 to 83 years）,and the interval from injury to hospital was （22.58±22.11 ） hours （ranged from 1 to 96 hours）,used open reduction and locking plate fixation surgery. In manipulation group： there were 21 males and 38 females,the mean age of the patients was （65.98±ll.10）years （ranged from 45 to 85 years）, and the interval from injury to hospital was （20.85±22.63） hours （ranged from 1 to 107 hours）, used manipulative re- duction and small splinting external fixation. All patients were evaluated with shoulder pain, function, activity and anatomical indicators after treatment. Results：All patients were followed up for 3 to 12 months with an average of 8.2 months. According to Neer Score ,the total scores was 85.47±6.15 in operation group, 84.95±5.70 in manipulation group. The satisfaction rate of the operation group were 88.20%, and the manipulation group were 86.40%. The difference was not statistically significant between two groups （P〉O.05）. Conclusion： The two treatment were able to achieve satisfactory results. The manipulative reduction and splinting treatment has the advantage of avoiding the risk of surgery,less blood damage, ensureing the efficacy, and reducing costs. It can effectively treat the proximal humerus three-part fracture.