手法复位杉树皮夹板固定治疗肱骨近端骨折的临床疗效观察

目的:观察手法复位杉树皮夹板固定治疗肱骨近端骨折的临床疗效.方法:将60例肱骨近端骨折患者分成外固定组和内固定组,每组30例.外固定组患者采用富阳张氏手法复位配合杉树皮夹板固定治疗,内固定组患者采用切开复位钢板内固定治疗.治疗后分别从复位情况、骨折愈合时间、Constant - Murley评分及患者满意度4个方面评价2组患者的临床疗效.结果:①骨折复位情况.内固定组骨折复位情况优于外固定组(Z=-3.850,P=0.000).②骨折愈合时间.外固定组所有患者骨折均愈合,内固定组1例未愈合,继发肱骨头坏死.外固定组骨折愈合时间比内固定组短(t =0.872,P=0.018).③肩关节功能.2组患者疼痛、日常生活能力、肩关节活动度、肌力及Constant - Murley总分比较,差异均无统计学意义(t=1.091,P=0.081；t=0.982,P=0.166;t=1.542,P=0.098;t =2.146,P=0.541；t=3.466,P=0.167).(④患者满意度.外固定组患者满意度高于内固定组(Z=-4.452,P=0.000).结论:采用手法复位杉树皮夹板固定治疗肱骨近端骨折可以获得与钢板内固定治疗相当的疗效,而且骨折愈合时间短、患者满意度更高,值得在临床推广应用.

Observation on the clinical curative effect of manipulative reduction combined with Chinese fir-bark splint fixation in the treatment of proximal humeral fracture

Objective：To observe the clinical curative effect of manipulative reduction combined with Chinese fir-bark splint fixation in the treatment of proximal humeral fracture（PHF）.Methods：Sixty PHF patients were divided into external fixation group and internal fixation group,30 cases in each group.Patients in the external fixation group were administrated with Fuyang Zhang＇s manipulative reduction combined with Chinese fir-bark splint fixation,while the others in the internal fixation group were administrated with open reduction and internal fixation.After the treatment,the clinical curative effects of the patients in the 2 groups were evaluated from the 4 aspects as reduction state,fracture healing time,Constant-Murley scores and patient satisfaction respectively.Results：①Fracture reduction state of internal fixation group was better than that of external fixation group（Z=-3.850,P=0.000）.②Fractures of all the patients in the external fixation group were all healed,while 1 case with unhealed fracture and secondary humeral head necrosis was found in internal fixation group.Fracture healing time of external fixation group was shorter than that of internal fixation group（t=0.872,P=0.018）.③There was no statistical difference in the aspects of pain,daily living ability,shoulder joint motion,muscle strength and Constant-Murley total scores between the 2 groups（t=1.091,P=0.081;t=0.982,P=0.166;t=1.542,P=0.098;t=2.146,P=0.541;t=3.466,P=0.167）.④Patient satisfaction of external fixation group was higher than that of internal fixation group（Z=-4.452,P=0.000）.Conclusion：With shorter fracture healing time and higher patient satisfaction,manipulative reduction combined with Chinese fir-bark splint fixation has the similar curative effect to that of open reduction and internal fixation in PHF treatment,and it is worth popularizing in the clinics.