Li Haibo, Wang Yue, Che Zheng, Gou Yongsheng, Xu Lin, Lu Bing
Department of Orthopaedics, the First People's Hospital of Shuangliu District, Chengdu Sichuan, 610200, P.R.China.
Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu Sichuan, 610072, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Aug 15;31(8):946-951. doi: 10.7507/1002-1892.201701021.
To investigate the effect of functional exercises at different time and different immobilization positions on the functional recovery of elbow joint with type C distal humeral fractures.
A total of 120 patients with type C distal humeral fractures admitted to the hospital between June 2013 and July 2015 were included in the study. They were randomly allocated to 3 groups, 40 patients in each group. Group A: functional exercises began immediately after the operation; Group B: the affected elbow was fixed at 90° flexion for 1 week and then began functional exercises after 1 week of immobilization; Group C: the affected elbow was fixed at 30° extension for 1 week and then began functional exercises after 1 week of immobilization. There was no significant difference in gender, age, fracture pattern, fracture side, injury time, and surgical approach between groups ( >0.05).
In groups A and B, 1 case had incision redness and swelling respectively, and the other incisions healed by first intention. Five patients occurred myositis ossificans in group A, 4 cases in group B, and 5 cases in group C. The incidence of complications in groups A, B, and C was 15.0% (6/40), 12.5% (5/40), and 12.5% (5/40), respectively. There was no significant difference between groups ( =0.144, =0.930). All patients were followed up 6-25 months, with an average of 9.8 months. At 2 weeks after operation, the Mayo elbow joint function score of group A was significantly higher than those of groups B and C ( <0.05), and the visual analogue scale (VAS) of group A was significantly lower than those of groups B and C ( <0.05). There was no significant difference between groups B and C ( >0.05). At 6 months after operation, there was no significant difference in Mayo elbow joint function score and VAS score between groups ( >0.05). At 2 weeks and 6 months after operation, the flexion and extension activities of elbow joint in groups A and C were better than that in group B ( <0.05), and there was no significant difference between groups A and C ( >0.05). There was no significant difference in forearm rotation between groups ( >0.05). All fractures of 3 groups achieved clinical healing, and there was no significant difference in healing time between groups ( >0.05).
Early functional exercises can relieve pain and obtain better elbow flexion and extesion activities after operation. The elbow joint fixed at 30° extension is better than at 90° flexion in elbow flexion and extension activitis.
探讨不同时间及不同固定体位的功能锻炼对肱骨远端C型骨折肘关节功能恢复的影响。
选取2013年6月至2015年7月收治的120例肱骨远端C型骨折患者纳入研究。将其随机分为3组，每组40例。A组：术后立即开始功能锻炼；B组：患侧肘关节屈曲90°固定1周，固定1周后开始功能锻炼；C组：患侧肘关节伸直30°固定1周，固定1周后开始功能锻炼。各组间性别、年龄、骨折类型、骨折侧别、受伤时间及手术方式比较，差异均无统计学意义（>0.05）。
A组和B组分别有1例切口红肿，其余切口均一期愈合。A组发生骨化性肌炎5例，B组4例，C组5例。A、B、C组并发症发生率分别为15.0%（6/40）、12.5%（5/40）、12.5%（5/40），组间比较差异无统计学意义（=0.144，=0.930）。所有患者均获随访6~25个月，平均9.8个月。术后2周时，A组Mayo肘关节功能评分显著高于B组和C组（<0.05），A组视觉模拟评分法（VAS）显著低于B组和C组（<0.05）。B组和C组间比较差异无统计学意义（>0.05）。术后6个月时，各组Mayo肘关节功能评分及VAS评分比较差异无统计学意义（>0.05）。术后2周及6个月时，A组和C组肘关节屈伸活动度优于B组（<0.05），A组和C组间比较差异无统计学意义（>0.05）。各组间前臂旋转差异无统计学意义（>0.05）。3组骨折均达临床愈合，组间愈合时间比较差异无统计学意义（>0.05）。
早期功能锻炼可减轻术后疼痛，获得较好的肘关节屈伸活动度。肘关节伸直30°固定在肘关节屈伸活动方面优于屈曲90°固定。
