Li Qi, Lin Guang-mao, Li Bao, Yang Guo-jing, Hu Shun-fu, Ma Jiang-yan, Lin Rui-xin, Cai Chun-yuan, Liu Min
The Third Hospital Affiliated to Wenzhou Medical College, Wenzhou 325200, Zhejiang, China.
Zhongguo Gu Shang. 2011 Jun;24(6):474-8.
To research the efficacy,security and necessity of combined therapy for preventing postsurgery stiffness after elbow fracture.
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 pa- tients 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.
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 +/- 1.99) 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).
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.
探讨联合治疗预防肘关节骨折术后僵硬的疗效、安全性及必要性。
2009年5月至2010年4月，将60例手术治疗的肘关节骨折患者随机分为两组：联合治疗组和传统治疗组。联合治疗组30例，男12例，女18例，年龄23～63岁，平均（43.53±7.74）岁；其中15例为两部分骨折，包括肱骨髁间骨折合并尺骨鹰嘴和（或）尺骨冠状突骨折8例，肱骨内外髁骨折合并桡骨头骨折3例，尺骨鹰嘴和尺骨冠状突骨折3例，尺骨鹰嘴和桡骨头骨折1例；另15例为一部分骨折，包括肱骨外髁或内髁骨折8例，尺骨鹰嘴或尺骨冠状突骨折6例，桡骨头骨折1例。传统治疗组30例，男11例，女19例，年龄24～67岁，平均（46.13±6.22）岁；其中两部分骨折15例，包括肱骨髁间骨折合并尺骨鹰嘴和（或）尺骨冠状突骨折7例，肱骨内外髁骨折合并桡骨头骨折2例，尺骨鹰嘴和尺骨冠状突骨折5例，肱骨髁间骨折合并桡骨头骨折1例；一部分骨折15例，包括肱骨外髁或内髁骨折6例，尺骨鹰嘴或尺骨冠状突骨折8例，桡骨头骨折1例；传统治疗组患者采用传统治疗方法。术后6个月采用Mayo肘关节功能评分（包括肘关节活动度）及安全性（采用X线复查骨折移位、内固定失败及异位骨化情况）进行评价。回顾性分析2002年至2006年30例患者作为历史对照组，男17例，女13例，年龄27～62岁，平均（47.17±7.83）岁；其中两部分骨折15例，包括肱骨髁间骨折合并尺骨鹰嘴和（或）尺骨冠状突骨折7例，肱骨内外髁骨折合并桡骨头骨折1例，尺骨鹰嘴和尺骨冠状突骨折6例，尺骨冠状突和桡骨头骨折1例；一部分骨折15例，包括肱骨外髁或内髁骨折9例，尺骨鹰嘴或尺骨冠状突骨折5例，桡骨头骨折1例。回顾性评价历史对照组患者术后6个月的Mayo肘关节功能评分，并与传统治疗组结果进行比较。
联合治疗组Mayo评分（91.00±7.81）高于传统治疗组（76.83±10.71）及历史对照组（73.17±1.99）（F=24.98，P<0.05）。联合治疗组肘关节活动度为（102.40±9.16）度，高于传统治疗组（83.57±6.21）度（t=9.325，P<0.05）。联合治疗组患者各次X线检查均未出现内固定松动、明显骨折移位及异位骨化。历史对照组Mayo评分为（73.17±11.99），与传统治疗组（76.83±10.71）比较差异无统计学意义（LSD，P=0.172）。
采用不同阶段、不同方法组合、不同个体的联合治疗预防肘关节骨折术后僵硬是有效、安全且必要的。
