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中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2022, Vol. 10 ›› Issue (02) : 148 -153. doi: 10.3877/cma.j.issn.2095-5790.2022.02.010

论著

改良张力支具对肱骨髁间骨折患者术后功能康复的临床效果评价
焦鑫1, 张堃2, 朱养均2, 宋哲2, 年跃文2, 张军2, 衡立松2, 蔡枭2,†()   
  1. 1. 716000　延安大学医学院
    2. 710054　西安交通大学附属红会医院创伤骨科
  • 收稿日期:2022-01-18 出版日期:2022-05-05
  • 通信作者: 蔡枭

Clinical evaluation of functional rehabilitation of patients with humeral intercondylar fractures and modified tension brace

Xin Jiao1, Kun Zhang2, Yangjun Zhu2, Zhe Song2, Yuewen Nian2, Jun Zhang2, Lisong Heng2, Xiao Cai2,†()   

  1. 1. Medical College of Yan'an University, Yan'an 716000, China
    2. Department of Orthopaedics and Traumatology, Affiliated Honghui Hospital of Xi'an Jiaotong University, Xi'an 710054, China
  • Received:2022-01-18 Published:2022-05-05
  • Corresponding author: Xiao Cai
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引用本文：

焦鑫, 张堃, 朱养均, 宋哲, 年跃文, 张军, 衡立松, 蔡枭. 改良张力支具对肱骨髁间骨折患者术后功能康复的临床效果评价[J]. 中华肩肘外科电子杂志, 2022, 10(02): 148-153.

Xin Jiao, Kun Zhang, Yangjun Zhu, Zhe Song, Yuewen Nian, Jun Zhang, Lisong Heng, Xiao Cai. Clinical evaluation of functional rehabilitation of patients with humeral intercondylar fractures and modified tension brace[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2022, 10(02): 148-153.

目的

探讨改良张力支具对肱骨髁间骨折患者术后功能康复的临床效果评价。

方法

回顾性分析本院采用切开复位内固定术治疗的40例肱骨髁间骨折患者的资料。单纯采用普通固定支具进行功能锻炼的为对照组（21例），采用改良张力支具进行功能锻炼的为观察组（19例）。比较两组患者术后去除支具和末次随访时肘关节屈曲度、肘关节背伸度、前臂旋前度、前臂旋后度和Mayo肘关节功能评分，以评定改良张力支具的疗效。

结果

所有患者术后均获得随访，平均随访13.79个月。观察组与对照组相比，术后去除支具时肘关节屈伸活动度[（104.47±12.37）° vs.（88.85±8.10）°，P<0.001]，差异有统计学意义；肘关节旋转活动度[（140.31±16.87）° vs.（135.66±12.86）°，P=0.331]，差异无统计学意义；肘关节Mayo评分[（78.84±5.04）分vs.（73.80±4.46）分，P=0.002]，差异有统计学意义。末次随访时肘关节屈伸活动度[（107.52±12.30）° vs.（93.00±8.47）°，P<0.001]，差异有统计学意义；肘关节旋转活动度[（141.42±17.02）° vs.（137.19±12.80）°，P=0.37]，差异无统计学意义；肘关节Mayo评分[（80.15±5.24）分vs.（74.95±4.18）分，P=0.001]，差异有统计学意义。

结论

术后使用改良张力支具可以改善肱骨髁间骨折患者的屈伸活动度和肘关节功能。

关键词: 肱骨髁间骨折, 改良张力支具, 肘关节功能, 效果评价
Background

At present, the adjustable brace can meet the needs of the elbow joint auxiliary stabilization and early functional exercise after the intercondylar fracture of the humerus. However, the adjustable brace still has certain disadvantages, so our hospital has improved the adjustable elbow brace, developed a relatively small tension, more flexible adjustment of the tension braces, and applied it to the postoperative rehabilitation exercises of clinical intercondylar fracture patients. Objective To investigate the clinical effect of modified tension braces on postoperative functional rehabilitation in patients with intercondylar humerus fractures.

Methods

The data of 40 patients with intercondylar fractures of the humerus treated by incision reduction and internal fixation were retrospectively analyzed. The control group (21 cases) used ordinary fixed braces for functional exercises alone, and the observation group (19 cases) used modified tension braces for practical exercises. The elbow flexion, dorsal elbow elongation, forearm rotation, forearm rotation, and Mayo elbow function score at postoperative brace removal and final follow-up were compared between the two groups to assess the efficacy of improving tension braces.

Results

All patients were followed up after surgery, with an average follow-up of 13.79 months. Compared with the control group, the ranges of motion of the elbow joint were [ (104.47±12.37) ° vs. (88.85±8.10) °, P <0.001] when removing the brace after surgery was observed. The ranges of motion of the elbow joint were [ (140.31±16.87) ° vs. (135.66±12.86) °, P=0.331] , and the difference was not statistically significant. The mayo scores of the elbow joint [ (78.84±5.04) points vs. (73.80 ± 4.46) points, P=0.002] , and the difference was statistically significant. The ranges of flexion and extension of the elbow at the last follow-up were [ (107.52±12.30) °vs. (93.00±8.47) °, P<0.001] , and the difference was statistically significant. The elbow rotational ranges of motion were [ (141.42±17.02) °vs. (137.19±12.80) °, P=0.37] , and the difference was not statistically significant. The elbow Mayo scores were [ (80.15± 5.24) points vs. (74.95±4.18) points, P=0.001] , and the difference was statistically significant.

Conclusions

The use of modified tension braces after surgery can improve the flexion range of motion and elbow joint function in patients with intercondylar humerus fractures.

Key words: Intercondylar fracture of humerus, Improved tension brace, Elbow function, Effect evaluation
图1 改良张力支具与佩戴
表1 患者一般情况分布比较
组别 例数 年龄（岁，±s） 性别（男/女） 侧别（左侧/右侧） AO分型
C1型 C2型 C3型
观察组 19 43.89±12.92 7/12 7/12 3 7 9
对照组 21 42.57±13.48 8/13 11/10 4 6 11
t或F值   0.316 0.00 0.97 0.416
P值   0.71 0.93 0.32 0.915
表2 两组患者屈伸、旋转和Mayo肘关节功能评分比较（±s）
组别 例数 屈伸活动度（°） 旋转活动度（°） Mayo肘关节功能评分（分）
去除支具时 末次随访时 去除支具时 末次随访时 去除支具时 末次随访时
观察组 19 104.47±12.37 107.52±12.30 140.31±16.87 141.42±17.02 78.84±5.04 80.15±5.24
对照组 21 88.85±8.10 93.00±8.47 135.66±12.86 137.19±12.80 73.8±4.46 74.95±4.18
t值   4.76 4.38 0.98 0.89 3.34 3.48
P值   <0.001 <0.001 0.331 0.37 0.002 0.001
图2 患者，男，52岁，入院主诊断为右肱骨髁间骨折　图A-B：术前X线片可见内髁明显移位；图C-F：CT及三维成像见关节面损伤严重；图G-H：于本院行尺骨鹰嘴截骨入路双钢板内固定治疗；图I-J：使用张力支具术后3个月复查见肘关节屈伸活动度108°
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