锁骨骨折切开复位内固定术后患者肩关节功能恢复的风险因素研究

Risk factors of shoulder joint function recovery in patients with clavicular fracture after open reduction and internal fixation

目的探讨锁骨骨折切开复位内固定术后患者肩关节功能恢复的风险因素。方法根据纳入及排除标准对2019年1月至2022年12月本院收治的332例锁骨骨折患者进行术后随访分析。根据术后不同时间对比其Constant-Murley肩关节功能评分,并建立单因素及多因素回归模型。结果锁骨骨折切开复位内固定术后患者在术后1周、1个月、3个月在Constant-Murley肩关节功能评分各方面均存在显著差异(P<0.05)。男性,受伤手不是优势手,没有照顾者,没有规范锻炼是术后肩关节功能得分降低的危险因素(P<0.05)。结论锁骨切开复位内固定术后肩关节功能逐渐改善,3个月基本能达到正常状态。为了更好地恢复肩关节功能,患者需要在术后积极进行规范的康复训练,并且可能需要有人照顾和帮助,对于非优势手受伤的患者,更应该注意其术后康复。

Background A clavicle fracture is a common fracture usually caused by direct violence(such as falling directly onto the ground)or indirect violence(such as impact in a car accident).Clinical manifestations of clavicular fracture include local swelling,subcutaneous stasis,tenderness,and possible deformity.In some cases,patients may also have symptoms such as limited shoulder movement and scapular pain.The typical clinical treatment for clavicular fractures includes conservative treatment and surgical treatment.Conservative treatment,including the use of a cast or a shoulder sling,is appropriate for undisplaced fractures.Surgical treatment is usually suitable for displaced fractures or other fractures,and internal fixation is often used,including the use of steel nails,plate screws,or shape memory alloy bone plates to fix the fracture site to promote healing.The recovery of shoulder joint function after surgery is essential for patients'quality of life.However,the rehabilitation process of shoulder joint function after surgical treatment may be affected by many factors,such as surgical method,fixed time,postoperative rehabilitation training,etc.Therefore,in-depth research on the status and influencing factors of shoulder joint function in different periods after surgery is significant for guiding clinical rehabilitation treatment.Objective To investigate the risk factors of shoulder joint function recovery in patients with clavicular fracture after open reduction and internal fixation.Methods According to the inclusion and exclusion criteria,332 patients with clavicular fractures admitted to our hospital from January 2019 to December 2022 were followed up and analyzed.Constant-Murley shoulder joint function scores were compared at different times after the operation,and univariate and multivariate regression models were established.Results There were significant differences in Constant-Murley shoulder joint function scores in patients with clavicular fracture after open reduction and internal fixation at one week,one month,and three months after surgery(all P<0.05).In men,the injured hand was not the dominant hand,and no caregiver care or regular exercise were risk factors for lower shoulder function scores after surgery(all P<0.05).Conclusion After open reduction and internal fixation of the clavicle,the function of the shoulder joint gradually improved,and it could reach normal in 3 months.In order to better restore shoulder joint function,patients need to carry out standardized rehabilitation training after surgery actively and may need someone to take care of them and help them.For patients with non-dominant hand injuries,more attention should be paid to their postoperative rehabilitation.