无痛手法松解粘连结合可调角度支具在儿童肱骨髁上骨折术后康复中的应用效果

Effectiveness of painless manual release of adhesion combined with adjustable angle brace fixation in postoperative rehabilitation of supracondylar fracture of humerus in children

目的观察全身麻醉下中医正骨手法松解粘连结合可调节角度支具固定在儿童肱骨髁上骨折术后早期康复中的临床效果。方法选取2020年3月至2022年3月湖北文理学院附属谷城人民医院收治的72例肱骨髁上骨折患儿作为研究对象,按随机数字表法将其分为对照组和观察组,每组36例。对照组采用常规康复锻炼,观察组在全身麻醉下用中医正骨手法松解粘连结合可调角度支具固定的方式进行康复锻炼。比较两组患儿在进行手法松解肘关节粘连时的疼痛程度,以及治疗3个月后两组患儿的肘关节整体功能恢复情况、肘关节功能达到显效所需时间和患儿家长对手法松解肘关节粘连过程的满意度。结果观察组未出现无法配合实施松解粘连的患儿,视觉模拟评分法(VAS)评分为0分,而对照组有10例患儿因疼痛抗拒手法治疗,VAS评分为(8.39±1.61)分。治疗3个月后,对照组患儿家长对手法松解肘关节粘连的满意度(52.78%)和患儿肘关节整体功能恢复的总有效率(77.78%)均低于对照组(94.44%、97.22%),而肘关节功能达到显效所需时间[(52.82±4.91)d]长于观察组[(30.82±3.65)d],差异均统计学意义(P<0.05)。结论对于肱骨髁上骨折的儿童,手术治疗3周后采用无痛中医正骨手法松解粘连结合可调角度支具固定,有利于肘关节功能的恢复,避免了肘关节僵硬,效果确切,且痛苦小,患儿家长更容易接受。

Objective To observe the clinical effect of painless traditional Chinese medicine bonesetting manual release adhesion combined with variable angle brace fixation in early postoperative rehabilitation of children′s supracondylar fracture of humerus.Methods A total of 72 children with supracondylar fracture of humerus treated in Gucheng People′s Hospital Affiliated to Hubei College of Arts and Sciences from March 2020 to March 2022 were selected and randomly divided into control group and observation group,36 cases in each group.The control group was treated with routine rehabilitation exercise,while the observation group was treated with traditional Chinese medicine bonesetting technique to release adhesion and fix with adjustable angle brace under the condition of general anesthesia.To compare the pain level of the children in the two groups during manipulation to release elbow joint adhesions,as well as the overall functional recovery of the elbow joints of the two groups after 3 months of treatment,the time required for elbow joints to reach the apparent effect,and the satisfaction level of children′patients with the process of manipulating the elbow joints to release the elbow joint adhesions.Results There were no children unable to cooperate with the implementation of adhesion release in the observation group,with a visual analog scale(VAS)score of 0,while 10 children in the control group resisted manipulation due to pain,with a VAS score of(8.39±1.61).After 3 months of treatment,the satisfaction of children′s patients with the release of elbow adhesions by manipulation(52.78%)and the overall effective rate of overall elbow function recovery of children(77.78%)in the control group were lower than those in the observation group(94.44%,97.22%),and the time required to achieve a significant effect on elbow function[(52.82±4.91)d]was longer than that in the observation group[(30.82±3.65)d],the differences were statistically significant(P<0.05).Conclusion For children with supracondylar fracture of humerus,painless traditional Chinese medicine bonesetting technique combined with adjustable angle brace after 3 weeks of surgical treatment is beneficial to the recovery of elbow joint function,avoiding elbow joint stiffness,with definite effect and little pain,and it is more acceptable to parents of children.