固定锁骨、肩胛骨手术对漂浮肩患者肩关节功能的影响分析

Effect of fixed clavicle and scapula operation on shoulder joint function of patients with floating shoulder

目的探讨固定锁骨联合肩胛骨手术在漂浮肩治疗中的应用价值,分析该术式对患者肩关节功能的影响。方法 2013年8月—2016年8月廊坊市第四人民医院收治漂浮肩患者86例,按手术方法分为锁骨+肩胛骨联合固定术治疗组(联合固定组,43例)和单独固定锁骨治疗组(单独固定组,43例),比较两组手术疗效,根据肩关节功能评分(Constant-Murley)标准评估患者治疗前、术后18个月末肩关节功能恢复效果,通过上门随访明确并发症发生率。结果联合固定组手术优良率为72. 09%,高于单独固定组的51. 16%,差异有统计学意义(P <0. 05);联合固定组治疗后的疼痛、日常活动、肌力、肩关节活动度及总分分别为(3. 51±0. 88)分、(20. 31±5. 27)分、(8. 51±2. 68)分、(44. 86±10. 53)分,均高于单独固定组,差异有统计学意义(P <0. 05);联合固定组并发症发生率为4. 65%,低于单独固定组的20. 93%,差异有统计学意义(P <0. 05)。结论锁骨+肩胛骨联合固定术能进一步改善漂浮肩患者的肩关节功能,降低并发症发生率,值得临床推广。

Objective To explore the application value of fixed clavicle combined with scapula operation in the treatment of floating shoulder,and to analyze the effect of the operation on the shoulder function of the patients.Methods Totally96patients with floating shoulders treated in our hospital from Aug.2013to Aug.2016were divided into group A and group B,with43cases in each group.Group A was treated by clavicle fixation combined with scapular joint fixation,and group B was treated with single clavicle fixation.The operative effects of the two groups were compared.The effect of shoulder joint function recovery was evaluated according to the shoulder joint function score(Contant-Murley)at the end of18months after treatment,and the incidence of complications was identified through door-to-door follow-up.Results The excellent rate of operation in group A was95.35%,which was higher than that of group B(81.40%),and the difference was statistically significant(P<0.05).The scores of pain daily activities,muscle strength,shoulder mobility and total scores in group A were(3.51±0.88)points,(20.31±5.27)points,(8.51±2.68)points,and(44.86±10.53)points,respectively,which were all higher than those in group B,and there was significant difference between the two groups(P<0.05).The incidence of complications in group A was4.65%,which was lower than that in group B(20.93%),and the difference was statistically significant(P<0.05).Conclusion The combined fixation of clavicle and scapula can further improve the shoulder function of the floating shoulder patients and reduce the incidence of complications,which is worthy of clinical promotion.