组合卡肩式夹板外固定治疗骨质疏松性肱骨近端骨折临床疗效观察

Clinical observation of osteoporotic proximal humeral fractures treated with combined clip-shoulder splint external fixation

目的:比较组合卡肩式夹板与传统超肩关节小夹板治疗骨质疏松性肱骨近端骨折(PHF)的疗效差异,评价夹板临床应用便捷性。方法:选取2015年2月至2017年2月甘肃中医药大学附属医院骨科住院的79例原发性骨质疏松性PHF患者,随机分为治疗组(组合卡肩式夹板外固定)40例,对照组(传统超肩关节小夹板外固定)39例,短期疼痛改善采用视觉模拟评分(VAS)、骨折临床愈合时间,远期肩关节功能恢复采用Constant-Murley评分标准,比较两组疗效差异;比较两组夹板调整次数评估使用便捷性;比较短期内骨折再移位、压疮情况评价并发症、安全性。结果:治疗组VAS值显著优于对照组(P<0.05);随访至骨折临床愈合,治疗组骨折愈合时间、夹板调整次数、压疮、骨折再移位方面均显著优于对照组(P<0.05);随访2年,在肩关节功能恢复方面(日常生活能力、疼痛、肩关节活动及肌力方面)两组差异均无统计学意义。结论:两种疗法在骨质疏松性PHF的治疗中远期疗效相似,但组合卡肩式夹板具有操作简便、短期并发症少等优势,值得推广。

Objective:To compare the clinical effect of combined clip-shoulder splint and traditional super-shoulder joint splint in the treatment of osteoporotic proximal humeral fracture(PHF)and to evaluate the convenience of clinical application of splint.Methods:A total of 79 patients with primary osteoporotic PHF were selected from the Department of Orthopaedics,Affiliated Hospital of Gansu University of Chinese Medicine from February 2015 to February 2017,the patients were randomly divided into two groups:40 cases in the treatment group(combined clip-shoulder external fixation)and 39 cases in the control group(traditional super-shoulder joint splint external fixation),short-term pain improvement by pain analog score(VAS),clinical healing time of fracture,long-term functional recovery of shoulder joint by Constant-Murley score.The curative effects of the two groups were compared.The adjustment times of splint were compared between the two groups to evaluate the convenience of use.The short-term displacement of fracture and pressure ulcer were compared to evaluate the complications and safety.Results:The VAS value of the treatment group was significantly better than that of the control group(P<0.05).The treatment group was significantly better than the control group in terms of fracture healing time,splint adjustment times,pressure ulcer and fracture redisplacement(P<0.05).After 2 years of follow-up,there was no significant difference in the recovery of shoulder function,including activities of daily living,pain,shoulder joint activity and muscle strength.Conclusion:The two methods are similar in the long-term efficacy of osteoporotic PHF,but the combined clip-shoulder splint has the advantages of simple operation and less short-term complications.It is worth popularizing in clinic.