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中华肩肘外科电子杂志 ›› 2024, Vol. 12 ›› Issue (03) : 216 -222. doi: 10.3877/cma.j.issn.2095-5790.2024.03.004

论著

锁骨骨折切开复位内固定术后患者肩关节功能恢复的风险因素研究
赵静磊1, 陈晓婷1, 夏莹1, 黄维佳1, 周菊1, 刘芳1,()   
  1. 1. 200120 上海,同济大学附属东方医院急诊外科;200120 上海,同济大学附属东方医院护理部
  • 收稿日期:2024-03-28 出版日期:2024-08-05
  • 通信作者: 刘芳

Risk factors of shoulder joint function recovery in patients with clavicular fracture after open reduction and internal fixation

Jinglei Zhao1, Xiaoting Chen1, Ying Xia1, Weijia Huang1, Ju Zhou1, Fang Liu1,()   

  1. 1. Department of Emergency Surgery, Shanghai East Hospital Affiliated to Tongji University, 200120 Shanghai, China; Department of Nursing, Shanghai East Hospital Affiliated to Tongji University, 200120 Shanghai, China
  • Received:2024-03-28 Published:2024-08-05
  • Corresponding author: Fang Liu
引用本文:

赵静磊, 陈晓婷, 夏莹, 黄维佳, 周菊, 刘芳. 锁骨骨折切开复位内固定术后患者肩关节功能恢复的风险因素研究[J]. 中华肩肘外科电子杂志, 2024, 12(03): 216-222.

Jinglei Zhao, Xiaoting Chen, Ying Xia, Weijia Huang, Ju Zhou, Fang Liu. Risk factors of shoulder joint function recovery in patients with clavicular fracture after open reduction and internal fixation[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2024, 12(03): 216-222.

目的

探讨锁骨骨折切开复位内固定术后患者肩关节功能恢复的风险因素。

方法

根据纳入及排除标准对2019年1月至2022年12月本院收治的332例锁骨骨折患者进行术后随访分析。根据术后不同时间对比其Constant-Murley肩关节功能评分,并建立单因素及多因素回归模型。

结果

锁骨骨折切开复位内固定术后患者在术后1周、1个月、3个月在Constant-Murley肩关节功能评分各方面均存在显著差异(P<0.05)。男性,受伤手不是优势手,没有照顾者,没有规范锻炼是术后肩关节功能得分降低的危险因素(P<0.05)。

结论

锁骨切开复位内固定术后肩关节功能逐渐改善,3个月基本能达到正常状态。为了更好地恢复肩关节功能,患者需要在术后积极进行规范的康复训练,并且可能需要有人照顾和帮助,对于非优势手受伤的患者,更应该注意其术后康复。

Background

A clavicle fracture is a common fracture usually caused by direct violence (such as falling directly onto the ground) or indirect violence (such as impact in a car accident) . Clinical manifestations of clavicular fracture include local swelling, subcutaneous stasis, tenderness, and possible deformity. In some cases, patients may also have symptoms such as limited shoulder movement and scapular pain. The typical clinical treatment for clavicular fractures includes conservative treatment and surgical treatment. Conservative treatment, including the use of a cast or a shoulder sling, is appropriate for undisplaced fractures. Surgical treatment is usually suitable for displaced fractures or other fractures, and internal fixation is often used, including the use of steel nails, plate screws, or shape memory alloy bone plates to fix the fracture site to promote healing. The recovery of shoulder joint function after surgery is essential for patients' quality of life. However, the rehabilitation process of shoulder joint function after surgical treatment may be affected by many factors, such as surgical method, fixed time, postoperative rehabilitation training, etc. Therefore, in-depth research on the status and influencing factors of shoulder joint function in different periods after surgery is significant for guiding clinical rehabilitation treatment.

Objective

To investigate the risk factors of shoulder joint function recovery in patients with clavicular fracture after open reduction and internal fixation.

Methods

According to the inclusion and exclusion criteria, 332 patients with clavicular fractures admitted to our hospital from January 2019 to December 2022 were followed up and analyzed. Constant-Murley shoulder joint function scores were compared at different times after the operation, and univariate and multivariate regression models were established.

Results

There were significant differences in Constant-Murley shoulder joint function scores in patients with clavicular fracture after open reduction and internal fixation at one week, one month, and three months after surgery (all P < 0.05) . In men, the injured hand was not the dominant hand, and no caregiver care or regular exercise were risk factors for lower shoulder function scores after surgery (all P < 0.05) .

Conclusion

After open reduction and internal fixation of the clavicle, the function of the shoulder joint gradually improved, and it could reach normal in 3 months. In order to better restore shoulder joint function, patients need to carry out standardized rehabilitation training after surgery actively and may need someone to take care of them and help them. For patients with non-dominant hand injuries, more attention should be paid to their postoperative rehabilitation.

图1 锁骨切开复位内固定术后患者不同时期肩关节功能变化得分的比较 图A:术后1周、1个月及3个月患者术后肩关节功能评分对比;图B:术后1周、1个月及3个月患者术后疼痛功能评分对比;图C:术后1周、1个月及3个月患者术后日常生活活动评分对比;图D:术后1周、1个月及3个月患者术后关节活动评分对比;图E:术后1周、1个月及3个月患者术后肌力对比
表1 不同特征的患者在不同时期肩关节功能变化得分的比较(n=267,±s
类别 例数 第1周 W P 第1月 W P 第3月 W P
年龄     5 362.5 0.540   6 010.5 0.491   6 141.5 0.347
>60岁 214 43.18±5.78     75.08±4.21     95.44±2.82    
≤60岁 53 42.77±5.62     75.94±4.53     95.85±2.93    
性别     6 371 0.007   6 716.5 0.032   6 291.5 0.005
177 43.76±5.45     75.89±3.99     95.88±2.69    
90 41.8±6.1     74±4.57     94.81±3.02    
BMI     8 712 0.965   7 907.5 0.173   8 665.5 0.905
异常 152 43.11±5.66     75.38±4.48     95.49±2.89    
正常 115 43.09±5.87     75.09±4.02     95.57±2.79    
抽烟     3 672 0.399   2 875.5 0.214   3 423.5 0.841
28 42.21±5.96     75.36±4.65     95.36±3.02    
239 43.2±5.72     75.24±4.25     95.54±2.83    
高血压     9 562 0.281   8 836.5 0.940   9 546 0.290
141 42.74±5.63     75.04±4.36     95.36±2.85    
126 43.5±5.86     75.49±4.2     95.7±2.84    
多发伤     4 556.5 0.489   4 717.5 0.278   4 499 0.574
37 42.43±5.91     75.22±4.38     95.3±2.78    
230 43.2±5.72     75.26±4.27     95.56±2.86    
骨折史     4 191.5 0.332   3 613.5 0.022   4 756 0.786
41 44.02±5.19     75.59±4.17     95.41±3.01    
226 42.93±5.83     75.19±4.31     95.54±2.82    
受伤手为优势手     9 465 0.015   9 787 0.002   11 532 <0.001
176 42.51±5.76     74.27±4.21     94.81±2.97    
91 44.23±5.55     77.15±3.76     96.9±1.96    
照顾情况     9 869.5 0.002   9 224.5 0.037   11 572.5 <0.001
无人 176 42.24±5.91     74.48±4.44     94.75±2.97    
有人 91 44.76±5.03     76.75±3.52     97.01±1.82    
规范功能锻炼     10 330 <0.001   10 453 <0.001   12 588 <0.001
173 42.09±5.86     74.06±4.22     94.56±2.88    
94 44.96±5.04     77.45±3.46     97.29±1.7    
表2 术后不同时间影响肩关节功能的单因素分析
表3 术后不同时间影响肩关节功能的多因素分析
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