渐进式功能锻炼对肱骨远端C型骨折双钢板内固定术后影响

Effect of Progressive Functional Exercise on Double Steel Plate Internal Fixation of Distal Humerus C TypeFracture

目的:探讨渐进式功能锻炼在肱骨远端C型骨折双钢板内固定术后对肘关节功能影响。方法:对纳入标准的80例肱骨远端C型骨折患者均给予双钢板内固定术,术后随机分为治疗组和对照组各40例,治疗组术后即可给予渐进式功能锻炼;对照组术后患肢于伸肘30°位石膏外固定制动,1周后(术后7~11天)开始功能锻炼。采用肘关节Mayo评分、肘关节活动度比较2组术后2周、术后3月、术后6月肘关节功能,并对术后6月并发症进行对比。结果:80例均获得随访,治疗组和对照组术后3月、术后6月肘关节疼痛、活动度、稳定性以及日常生活活动能力与术后2周比较,差异均有统计学意义(P<0.05);术后3月、术后6月治疗组肘关节疼痛评分均高于对照组(P<0.05);治疗组和对照组术后3月、术后6月肘关节屈曲度、肘关节伸直差值度、前臂旋前度及前臂旋后度与术后2周比较,差异均有统计学意义(P<0.05);术后3月、术后6月治疗组肘关节屈曲度,肘关节伸直差值度,前臂旋前度,前臂旋后度均高于对照组(P<0.05);术后3月两组优良率经Wilcoxon秩和检验(Z=–1.976,P<0.05);术后6月两组优良率经Wilcoxon秩和检验(Z=–2.042,P<0.05);2组术后6月均无出现切口感染及血管神经损伤,术后总并发症比较差异无统计学意义(P>0.05)。结论:肱骨远端C型骨折双钢板内固定术后早期渐进式功能锻炼在肘关节活动度、功能恢复、疼痛缓解方面具有明显优势,且安全可靠。

Objectives To investigate the effect of progressive functional exercise on elbow joint function after double steel plate internal fixation for distal humerus C type fractures.Methods Eighty patients with distal humerus C type fractures that accorded with the inclusion criteria treated with double steel plate internal fixation were selected and randomly divided into treatment group and control group after operation(n=40).After operation,the patients in treatment group were given progressive functional exercise.In the control group,the affected limb was fixed and braked at the position of 30°elbow extension,and functional exercise was started one week later(7–11 days after operation).Elbow joint function was compared between the two groups 2 weeks,3 months and 6 months postoperatively by elbow joint Mayo scale;the elbow range of motion and complications 6 months after surgery were compared.Results All the 80 patients were followed up,the treatment group and control group in elbow joint pain,activity,stability and ADL ability were significantly different between 3 months and 6 months after surgery and 2 weeks after surgery(P<0.05);the pain scores of the elbow joints in the treatment group were higher than those in the control group at 3 months and 6 months after operation(P<0.05);The treatment group and control group in elbow flexion,elbow extension,forearm pronation and forearm curl were significantly different between 3 months and 6 months after surgery and 2 weeks after surgery(P<0.05).The elbow flexion,elbow straight difference degrees,Forearm pronation degrees and Forearm curl degrees of the treatment group 3 months and 6 months after operation were higher than those of the control group (P <0.05);3 months after surgery, Wilcoxon rank sum test was performed on the rates of excellent and good inthe two groups (Z = –1.976, P<0.05). 6 months after surgery, Wilcoxon rank-sum test was performed on theexcellent and good rates of the two groups (Z = –2.042, P <0.05);No incision infection or vascular and nerveinjury occurred in the two groups 6 months after surgery, and the comparison of total postoperative complicationswas not statistically significant (P >0.05). Conclusions Early progressive functional exercise after doublesteel plate internal fixation of distal humerus C type fractures has obvious advantages in elbow range of motion,functional recovery and pain relief, which is safe and reliable.