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[1]劉凱,尚如國,梁志超,等.老年肱骨近端骨折后肩關(guān)節(jié)功能恢復(fù)的影響因素分析[J].中醫(yī)正骨,2018,30(09):39-41.
　LIU Kai,SHANG Ruguo,LIANG Zhichao,et al.Analysis of factors influencing shoulder function recovery after proximal humeral fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(09):39-41.
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老年肱骨近端骨折后肩關(guān)節(jié)功能恢復(fù)的影響因素分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年09期
頁碼:
39-41
欄目:
基礎(chǔ)研究
出版日期:
2018-09-20

文章信息/Info

Title:
Analysis of factors influencing shoulder function recovery after proximal humeral fractures in the aged
作者:
劉凱; 尚如國; 梁志超; 胡建煒; 喻永新
廣東省廣州市正骨醫(yī)院,廣東 廣州 510030
Author(s):
LIU Kai; SHANG Ruguo; LIANG Zhichao; HU Jianwei; YU Yongxin
Guangzhou Orthopedic Hospital,Guangzhou 510030,Guangdong,China
關(guān)鍵詞:
肩骨折;  肱骨骨折;  肩關(guān)節(jié);  功能恢復(fù);  影響因素分析;  老年人
Keywords:
shoulder fractures;  humeral fractures;  shoulder joint;  recovery of function;  root cause analysis;  aged
摘要:
探討老年肱骨近端骨折后肩關(guān)節(jié)功能恢復(fù)的影響因素。方法:收集2015年8月至2017年3月在廣東省廣州市正骨醫(yī)院治療的老年肱骨近端骨折患者的病例資料,包括患者的性別、年齡、骨折分型、治療方法、骨折愈合情況、并發(fā)癥、功能鍛煉情況及肩關(guān)節(jié)功能評分。骨折分型采用Neer分型標(biāo)準(zhǔn),骨折愈合情況根據(jù)影像學(xué)標(biāo)準(zhǔn)評定,肩關(guān)節(jié)功能評價采用Constant-Murley評分。結(jié)果:共收集到122例獲得隨訪患者的病例資料,隨訪時間12～19個月,中位數(shù)14個月。男50例,女72例。年齡≥70歲69例,年齡<70歲53例。肱骨近端骨折Neer分型,Ⅰ型21例、Ⅱ型42例、Ⅲ型43例、Ⅳ型16例。非手術(shù)治療80例,手術(shù)治療42例。治療后遵醫(yī)囑進行功能鍛煉55例,未進行功能鍛煉67例。骨折愈合情況,優(yōu)55例、良38例、可24例、差5例。隨訪期間15例患者出現(xiàn)并發(fā)癥,其中皮膚過敏或潰爛5例、切口感染2例、內(nèi)固定失效1例、肱骨頭壞死2例、骨折畸形愈合5例。男性組與女性組、年齡≥70歲組與年齡<70歲組、非手術(shù)治療組與手術(shù)治療組的肩關(guān)節(jié)功能評分比較,組間差異均無統(tǒng)計學(xué)意義[(75.94±6.03)分,(77.04±5.83)分,t=1.012,P=0.314;(75.91±5.99)分,(77.47±5.75)分,t=1.450,P=0.150;(76.39±5.95)分,(76.98±5.89)分,t=-0.521,P=0.603]; 骨折Neer分型為Ⅰ型和Ⅱ型患者的肩關(guān)節(jié)功能評分高于Ⅲ型和Ⅳ型患者[(79.94±4.26)分,(73.02±5.33)分,t=7.946,P=0.000]; 有并發(fā)癥患者的肩關(guān)節(jié)功能評分低于無并發(fā)癥患者[(72.20±4.68)分,(77.21±5.82)分,t=3.184,P=0.002]; 骨折愈合情況為優(yōu)、良患者的肩關(guān)節(jié)功能評分高于可、差患者[(78.77±5.74)分,(72.45±4.41)分,t=4.678,P=0.000]; 遵醫(yī)囑進行功能鍛煉患者的肩關(guān)節(jié)功能評分高于未遵醫(yī)囑進行功能鍛煉的患者[(78.88±5.36)分,(73.80±5.36)分,t=-5.206,P=0.000]。結(jié)論:骨折分型、并發(fā)癥、骨折愈合情況及功能鍛煉情況,是老年肱骨近端骨折后肩關(guān)節(jié)功能恢復(fù)的影響因素。
Abstract:
To explore the factors influencing shoulder function recovery after proximal humeral fractures in the aged.Methods:The medical records of patients with proximal humeral fractures who were treated in Guangzhou Orthopedic Hospital from August 2015 to March 2017 were collected.The collected clinical data included gender,age,classification of fractures,treatment,fracture healing,complications,functional exercise and shoulder function scores.The fractures was classified according to Neer classification standard,and the fracture healing was assessed according to imaging standard,and the shoulder function was evaluated by using Constant-Murley scores.Results:The clinical data of 122 patients were collected.The patients were followed up for 12-19 months with a median of 14 months and they consisted of 50 males and 72 females.Sixty-nine patients were≥70 years old and 53 patients were<70 years old.The factures belonged to typesⅠ(21),Ⅱ(42),Ⅲ(43)andⅣ(16)according to Neer classification standard of proximal humeral fractures.Non-operative treatment was performed on 80 patients and operative treatment was performed on 42 patients.Fifty-five patients performed functional exercises by doctor's advice after the treatment and 67 patients didn't perform functional exercises.Fifty-five patients obtained an excellent result of fracture healing,38 good,24 fair and 5 poor.The complications including skin allergy or ulceration(5),incision infection(2),failed internal fixation(1),humeral head necrosis(2)and fracture malunion(5)were found during the follow-up period.There was no statistical difference in shoulder function scores between male patients and female patients,and between patients≥70 years and patients<70 years and between non-operative treatment group and operative treatment group(75.94+/-6.03 vs 77.04+/-5.83 points,t=1.012,P=0.314; 75.91+/-5.99 vs 77.47+/-5.75 points,t=1.450,P=0.150; 76.39+/-5.95 vs 76.98+/-5.89 points,t=-0.521,P=0.603).The shoulder function scores were higher in patients with Neer typeⅠandⅡfratures compared to patients with Neer typeⅢandⅣ fratures(79.94+/-4.26 vs 73.02+/-5.33 points,t=7.946,P=0.000),and were lower in patients with complications compared to patients without complications(72.20+/-4.68 vs 77.21+/-5.82 points,t=3.184,P=0.002),and were higher in patients who obtained excellent and good results of fracture healing compared to patients who obtained fair and poor results of fracture healing(78.77+/-5.74 vs 72.45+/-4.41 points,t=4.678,P=0.000),and were higher in patients who performed functional exercises by doctor's advice compared to patients who didn't perform functional exercises(78.88+/-5.36 vs 73.80+/-5.36 points,t=-5.206,P=0.000).Conclusion:Classification of fractures,complications,fracture healing and functional exercises are the factors influencing shoulder function recovery after proximal humeral fractures in the aged.

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備注/Memo

備注/Memo:
基金項目:廣州市越秀區(qū)科技計劃項目(2015-WS-026)
更新日期/Last Update: 2018-09-20