综合疗法预防肘部骨折手术后肘关节僵硬的病例对照研究

目的：研究综合疗法对预防肘部骨折术后肘关节僵硬的有效性、安全性和必要性。方法：自2009年5月至2010年4月收集肘部骨折经手术内固定患者60例,分为2组。一组30例应用综合疗法,其中男12例,女18例;年龄23～63岁,平均（43.53±7.74）岁;两部位以上骨折15例（髁间合并鹰嘴及或尺骨冠状突骨折8例,内外肱骨髁合并桡骨小头骨折3例,鹰嘴合并冠状突骨折3例,鹰嘴合并桡骨小头骨折1例）,一处骨折15例（肱骨内或外髁骨折8例,尺骨鹰嘴或冠状突骨折6例,桡骨小头骨折1例）。另一组30例按以往程序治疗,其中男11例,女19例;年龄24～67岁,平均（46.13±6.22）岁;两部位以上骨折15例（髁间合并鹰嘴及或冠状突骨折7例,内外髁合并桡骨小头骨折2例,鹰嘴合并冠状突骨折5例,髁间合并桡骨小头骨折1例）,一处骨折15例（肱骨内或外髁骨折6例,尺骨鹰嘴或冠状突骨折8例,桡骨小头骨折1例）。两组在术后6个月复查时,进行Mayo肘关节功能评分（包括肘关节活动度）,以及安全性评定（X线复查包括骨折移位、内固定失效、异位骨化等方面）。随机选取2002年至2006年30例肘部骨折经手术内固定的病例作为历史对照,其中男17例,女13例;年龄27～62岁,平均（47.17±7.83）岁;两部位以上骨折15例（髁间合并鹰嘴及或冠状突骨折7例,内外髁合并桡骨小头骨折1例,鹰嘴合并冠状突骨折6例,冠状突合并桡骨小头骨折1例）,一处骨折15例（肱骨内或外髁骨折9例,尺骨鹰嘴或冠状突骨折5例,桡骨小头骨折1例）,这组回顾性进行术后6个月Mayo肘关节功能评分,与以往程序组进行比较。结果：术后6个月Mayo评分综合疗法组的（91.00±7.81）分,优于以往程序组的（76.83±10.71）分和历史对照组的（73.17±11.99）分（F=24.98,P〈0.05）。其中肘关节屈伸活动度,综合疗法组的（102.40±9.16）°,优于以往程序组的（83.57±6.21）°（t=9.325,P〈0.05）。综合疗法组经每次X线复查未发现内固定失效松脱、明显的骨折移位、异位骨化等现象。以往程序组Mayo评分（76.83±10.71）分与历史对照组的（73.17±11.99）分无明显差异（LSD两两比较,P=0.172〉0.05）。结论：综合疗法分阶段不同治疗方法组合由不同主体实施来预防肘部骨折手术后肘关节僵硬,是一种有效、安全和必要的方法。

Case-control study on combined therapy for preventing postsurgery stiffness after elbow fracture

Objective: To research the efficacy,security and necessity of combined therapy for preventing postsurgery stiffness after elbow fracture. Methods: From May 2009 to April 2010,60 patients with elbow fractures treated by operation were randomly divided into two groups:combined therapy group and past procedure group. Thirty patients in the combined therapy group,including 12 males and 18 females,ranging in age from 23 to 63 years,averaged(43.53±7.74) years old;15 patients had two parts fractures,including humeral intercondylar fractures combined with olecroanon and(or) ulna coronoid process fractures in 8 cases,fractures of exterior and interior humeral condyle combined with capitulum radius in 3 cases,fractures of olecroanon and ulna coronoid process in 3 cases,fractures of olecroanon and capitulum radius in 1 case;other 15 patients had one part fractures,including fractures of exterior or interior humeral condyle in 8 cases,fractures of olecroanon or ulna coronoid process in 6 cases,fractures of capitulum radius in 1 patient. Thirty patients in the past procedure group,including 11 males and 19 females,ranging in age from 24 to 67 years,averaged (46.13±6.22) years;15 patients had two parts fractures,including fractures of humeral intercondylar fracture combined with olecroanon and(or) ulna coronoid process in 7 cases,fractures of exterior and interior humeral condyle combined with capitulum radius in 2 cases,fractures of olecroanon and ulna coronoid process in 5 cases,fractures of humeral intercondylar fracture combined with capitulum radius in 1 patient;15 patients had one part fracture,including fractures of exterior or interior humeral condyle in 6 cases,fractures of olecroanon or ulna coronoid process in 8 cases,fractures of capitulum radius in 1 patient;the patients in the past procedure group were treated with past procedure methods. Mayo Elbow Performance Score(including gmotion of elbow joint) and security(using X-ray to recheck displacement fracture,internal fixation failure and heterotopic ossification)were evaluated at postoperative 6 months. From 2002 to 2006,30 patients were reviewed as historical control group,including 17 males and 13 females,ranging in age from 27 to 62 years,averaged(47.17±7.83)years;15 patients had two parts fractures,including fractures of humeral intercondylar combined with olecroanon and(or) ulna coronoid process in 7 cases,fractures of exterior and interior humeral condyle combined with capitulum radius in 1 case,fractures of olecroanon and ulna coronoid process in 6 cases,fractures of ulna coronoid process and capitulum radius in 1 case;15 patients had one part fractures,including fractures of exterior or interior humeral condyle in 9 cases,fractures of olecroanon or ulna coronoid process in 5 cases,fractures of capitulum radius in 1 case. The Mayo Elbow Performance Score of the patients in historical control group was evaluated retrospectively at postoperative 6 months and the results were compared with that of past procedure group. Results: Mayo score of combined therapy group was (91.00±7.81)surpassed to(76.83±10.71)of the past procedure group and(73.17±11.99)of historical control group(F=24.98,P<0.05).The range of motion of elbow was(102.40±9.16)degrees of combined therapy group surpassed to(83.57±6.21)degrees of the past procedure group(t=9.325,P<0.05). There were no internal fixation loose,obvious fracture displacement and heterotopic ossification in each X-ray examination of patients in the combined therapy group. The Mayo score of historical control group was(73.17±11.99),showing no significant differences when compared with(76.83±10.71)of the past procedure group(LSD,P=0.172). Conclusion: Combined therapy including different stage,different method combination and different subject to practice to prevent postsurgery stiffness after elbow fracture is effect,security and necessity.