锁骨骨折切开复位内固定术后患者肩关节功能变化及影响因素研究

Changes of shoulder joint function in patients with clavicle fractures after open reduction and internal fixation and its influencing factors

目的探讨锁骨骨折切开复位内固定术后患者不同时期的肩关节功能变化,并分析其影响因素。方法采用便利抽样法选取2019年1月-2020年6月上海市东方医院收治的120例锁骨骨折后行切开复位内固定术患者,于术后1周、术后1个月、术后3个月采用一般资料调查表和肩关节功能Constant-Murley量表对其进行调查。结果锁骨骨折切开复位内固定术后患者在术后1周、术后1个月、术后3个月的肩关节功能总评分分别为(42.91±7.38)、(73.13±3.96)、(98.04±3.89)分。重复方差分析显示,锁骨骨折切开复位内固定术后患者在不同时期的疼痛、日常生活活动、关节活动度、肌力、肩关节功能总分方面差异有统计学意义(P<0.01)。术后1周,锁骨骨折切开复位内固定术后患者在不同年龄、有无照顾者、功能锻炼情况方面的肩关节功能变化差异有统计学意义(P<0.05)。术后1个月,功能锻炼情况不同的患者肩关节功能变化差异有统计学意义(P<0.05)。术后3个月,不同特征的患者在肩关节功能得分方面差异无统计学意义(P>0.05)。多因素分析结果显示,年龄、照顾者、功能锻炼情况是锁骨骨折切开复位内固定术后1周肩关节功能的影响因素(P<0.05)。结论锁骨骨折切开复位内固定术后不同时期的肩关节功能有不同特点,提示在急性期应该关注手术部位的伤口疼痛,医务人员及照顾者给予患者日常照护及心理疏导;在亚急性期应加强关节锻炼,开展延续性护理,保证康复锻炼的持续有效性。

Objective To explore the changes of shoulder joint function in patients with clavicle fractures after open reduction and internal fixation at different periods,and analyze its influencing factors.Methods From January 2019 to June 2020,convenience sampling was used to select 120 clavicle fracture patients with open reduction and internal fixation in Shanghai East Hospital.Patients were investigated using the General Information Questionnaire and the Constant-Murley Score for shoulder joint function at one week,one month,and three months after the operation.Results The total scores of shoulder joint function of patients at one week,one month and three months after open reduction and internal fixation of clavicle fractures were(42.91±7.38),(73.13±3.96)and(98.04±3.89),respectively.Repeated analysis of variance showed that patients with clavicle fractures after open reduction and internal fixation had statistically significant differences in pain,activities of daily living,joint range of motion,muscle strength,and total score of shoulder joint function in different periods(P<0.01).One week after the operation,there were statistically significant differences in shoulder joint function of patients with clavicle fractures after open reduction and internal fixation at different ages,with or without caregivers,and functional exercise(P<0.05).One month after the operation,there was a statistically significant difference in shoulder joint function in functional exercise(P<0.05).Three months after the operation,there was no significant difference in the scores of shoulder joint function among patients with different characteristics(P>0.05).The results of multivariate analysis showed,age,caregivers and functional exercise were the influencing factors of shoulder joint function one week after open reduction and internal fixation(P<0.05).Conclusions There are different characteristics of shoulder joint function in different periods after open reduction and internal fixation of clavicle fractures.In the acute phase,attention should be paid to the wound pain at the surgical site,and medical and nursing staff and caregivers should provide daily care and psychological counseling to the patient.In the subacute phase,joint exercises should be strengthened and continuous nursing should be carried out to ensure the continuing effectiveness of rehabilitation exercises.