中医“动静平衡理念”指导下肘关节骨折术后康复功能锻炼的研究
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摘要
目的:通过对两组不同肘关节功能锻炼方法患者的疗效观察,比较肱骨髁间骨折术后患者的肘关节功能,探讨功能锻炼的动静平衡理念。
方法:将符合病例纳入标准的55例患者随机分为2组,治疗组27例,对照组28例,进行骨折术后康复的定期临床疗效观察。对我院在2003年9月～2010年06月间治疗的55例骨折患者进行了随访,平均随访时间18个月。结果按HHS的功能标准进行评分,并对其中的病例数据进行统计学分析。
结果:临床研究表明,临床疗效方面,观察1组与观察2组比较均有显著性差异(P<0.05),有明显的统计学意义。在HHS的功能标准评分下,观察1组与观察2组比较有显著性差异(P<0.05),有统计学意义。
结论:中医“动静平衡理念”指导下的肱骨髁间骨折术后锻炼在肘关节HHS标准评分下有着明显的优势及临床疗效,在早期康复有积极的意义。
Objective: based on two different elbow functional exercise methods, compares the clinical observation on patient condylar fractures postoperative patients humerus between the elbow functions, this paper discusses the function of dynamic balance concept exercise.
Methods: the cases of inclusion criteria with 55 patients were randomly divided into two groups: treatment group in 27 cases and control 28 patients, the postoperative rehabilitation on fracture regularly clinical curative effect observation.In our in September 2003 ~ 2010 - June 55 cases fractures between treatment of patients were followed, average follow-up time 18 months. According to the function of the HHS standards, and the rating of the statistical analysis of case data.
Results: clinical studies show that clinical curative effect of group 1, observe two groups of comparisons with observation are significant difference (P < 0.05), have obvious statistical significance.
Conclusion: static balance concept "TCM" under the guidance of between humeral condyle elbow joint exercises in fracture under HHS standards has obvious advantages ratings and clinical curative effect, in early recovery have positive significance. Under function of the HHS, observing scale scores of group 1 and group 2 have significant difference (P < 0.05), with a statistical significance.
方法:将符合病例纳入标准的55例患者随机分为2组,治疗组27例,对照组28例,进行骨折术后康复的定期临床疗效观察。对我院在2003年9月～2010年06月间治疗的55例骨折患者进行了随访,平均随访时间18个月。结果按HHS的功能标准进行评分,并对其中的病例数据进行统计学分析。
结果:临床研究表明,临床疗效方面,观察1组与观察2组比较均有显著性差异(P<0.05),有明显的统计学意义。在HHS的功能标准评分下,观察1组与观察2组比较有显著性差异(P<0.05),有统计学意义。
结论:中医“动静平衡理念”指导下的肱骨髁间骨折术后锻炼在肘关节HHS标准评分下有着明显的优势及临床疗效,在早期康复有积极的意义。
Objective: based on two different elbow functional exercise methods, compares the clinical observation on patient condylar fractures postoperative patients humerus between the elbow functions, this paper discusses the function of dynamic balance concept exercise.
Methods: the cases of inclusion criteria with 55 patients were randomly divided into two groups: treatment group in 27 cases and control 28 patients, the postoperative rehabilitation on fracture regularly clinical curative effect observation.In our in September 2003 ~ 2010 - June 55 cases fractures between treatment of patients were followed, average follow-up time 18 months. According to the function of the HHS standards, and the rating of the statistical analysis of case data.
Results: clinical studies show that clinical curative effect of group 1, observe two groups of comparisons with observation are significant difference (P < 0.05), have obvious statistical significance.
Conclusion: static balance concept "TCM" under the guidance of between humeral condyle elbow joint exercises in fracture under HHS standards has obvious advantages ratings and clinical curative effect, in early recovery have positive significance. Under function of the HHS, observing scale scores of group 1 and group 2 have significant difference (P < 0.05), with a statistical significance.
引文
[1] Ring D, Jupiter JB. Fractures of the distal humerus[J]. Orthop Clin rth(Am),2000,1 :103-113
[2]张殿英,姜保国,付中国,等.外固定支架在儿童骨折中的应用研究[J].中华创伤骨科杂志,2002,1:28-30.
[3]蒋协远,张力丹,刘兴华,等.可活动的铰链外固定架在肘部创伤治疗中的应用[J].中华外科杂志,2004,12:737-740.
[4] Pennig D, Gausepohl T, Mader K. Trans articular fixation with the capacity for motion in fracture dislocations of the elbow[J]. Injury,2000,1:35-44.
[5] Fornasieri C ,Staub C, Tourne Y, etal. Biomechanical comparative study of three types of synthesis in the treatment of supra and intercondylar fractures of the humerus in adults[J]. Rev Chir Orthop Reparatrice Appar Mot,1997,3:237-242.
[6]许申明,白书臣,宋耀发,等.桡侧张力带结合拉力螺钉内固定治疗肱骨髁间骨折[J].中国矫形外科杂志,2003,11(24):1716,1717.
[7] Allende C A, Allende B T, Allende B L, et al. Intercondylar distal humerus fractures surgical treatment and results[J]. Chir Main, 2004, 2:85-95.
[8]卢华定,蔡道章,金文涛,等. AO双钢板内固定治疗肱骨髁间骨折[J].中国矫形外科杂志,2008,3:408-410.
[9] Helfet DL, Hotchkiss RN. Interal fixation of the distal humerus :a biomechanical comparison of methods[J].J Orthop Trauma,1990,4:260.
[10] Eralp L, Kocaoglu M,Sar C,et al. Surgical treatment of distal intra articular humeral fractures in adults[J].Iht Orthop,2001,25:46-50.
[11] Yang KH, Park HW, Park SJ, etal. Lateral J , plate fixation in comminuted inter-condylar fracture of the humorous[J].Arch Northrop Trauma Surg,2003,123:234-238.
[12]卢世璧主译.坎贝尔骨科学.北京:人民军医出版社,2008,第九版;688
[13]胥少汀,葛宝丰,徐印坎主编.实用骨科学.北京:人民军医出版社,2005,第3版;466
[14]王亦璁主编.骨与关节损伤[M].北京:人民卫生出版社,2007;第四版325
[15]方先之,等.中西医结合治疗骨折[J].北京卫生出版社,1996
[16]尚天裕,等.中西医治疗骨折新法[J].骨科附刊,试刊号1978;8
[1]张磊,原林,戴景兴等肱骨髁间骨折3种内固定的生物力学比较[J].解放军医学杂志,2005,30(4):339-341
[2]黄雷,张波,王满宜,等.肱骨髁间骨折的手术治疗[J].中华骨科杂志,2001 21(3):158-162
[3]丁卫华,刘明.经鹰嘴截骨肘后入路显露方式的探讨[J].中华骨科杂志,2000,20:508-509
[4]苗全顺.肱骨髁间骨折不同手术入路64例疗效分析[J].中国药物与临床,2007,7(4):304
[5]沈国平,彭水岳,毛汉兴,等.肱骨髁间骨折的手术治疗[J].中医正骨,2005,17(6):47
[6]吴英华,张铁良,金硕,等.经尺骨鹰嘴关节外斜形截骨治疗肱骨髁间骨折[J].中华骨科杂志,2005,8:472-475
[7]明立功,明新月,明新杰,等.经尺骨鹰嘴截骨治疗肱骨髁间C型骨折[J].中国骨与关节损伤杂志,2007,22(7):567-569
[8] Man ueddua,hoffmeyer,haluickym,etal. Distal humeral fracture In adults : functional evaluation and measurement of isometric strength[J].Rev Chirortho Prepara triee Appar Mot,1997,83(6):551-560
[9] Schild hauerta, norkse, miuswj, etal. Extensor mechanism-sparing Paretic Petal posteriori Praetor the distal humorous[J] .Jortho Trauma,2003,17(5):374-378
[10] Mckeemd, wilstont, etal﹒ Fractional outcome following Surgical treatment of intra- articular distal humeral factures through posterior Propane[J].Bone Joint Surg(Am),2008,2(12):1701-1707
[11]川朱利军,江开良,杨林,等.经肱三头肌两侧入路AO重建钢板内固定治疗肱骨髁间骨折[J].中华创伤骨科杂志,2006,8(6):577
[12]黄令坚,黄春福,王鸿太,等.多切口入路结合多块钢板固定治疗肱骨髁间骨折[J].中国骨与关节损伤杂志,2007,22(4):315-316
[13]张秋林,赵杰,王家林,等.肱骨远端关节内粉碎性骨折的内固定治疗[J].中国矫形外科杂志,2001,8(4):342-344
[14]王友华,刘瑶,周振宇,等.三种内固定方法治疗肱骨髁间粉碎性骨折的疗效比较[J].中华创伤骨科杂志,2006,8(8)701-705
[15] Driscollsw.optimizing stability in distal humeral fracture fixation[J]. J Shoulder Elbow Surg,2005,14(Suppl S):186S-194S
[16] Elhager,Maynouc, Jugnetpm, etal. long term results of the surgical Treatment of bieondylar fractures of the distal humorous extremity in adults[J].Charmin,2001,20(2):144-154
[17] Guptar,khanchandanip Intercondylar fractures of the distal humorous in adults: critical analysis of 55 eases[Jury,2002,33(6):511-515
[18] Komer ,Diederichs G,Jzdorf M, etal. A biomechanical evaluation of methods of distal humorous fracture fixation using locking compression Plate versus conve- ntional Reconstruction Plates [J].Jortho P Trauma,2004,18:286-293
[19] RuehDS, TriePel CR.Hinged elbow fixation for recurrent instability following Fracture dislocation [J].Injury,2001,32(4):70
[20] Frankle MA,Hersovieid JR, DI pasquale TG, etal·A comparison of open reduction And internal fixation and Primary total elbow arthroplasty in the treatment of intra- articular distal Humorous fractures in women older than age65 [J].JorthoPTrauma,2003,17:473-480
[21]王盛,孙铭,吕庆生.经尺骨鹰嘴关节外截骨应用解剖钛钢板治疗肱骨远端骨折[J].中国现代医学杂志,2007,1716:2032-2034
[22] Eralpl,Kocaoglu M,Sar C,etal. Surgical treatment of distal intra-ocular humeral Fractures in adults[J].orthop,2001,25:46-50
[23] Huang TL,Chiu FY,Chuang TY,etal. The results of open reduction and intimae Fixation in elderly Patients with severe fractures of the distal humorous :article analysis of the results[J].J Trauma,2005,58:62-69
[24] Ramseyml, Bratieak,Getzcl. open reduction and intimae fixation of distal Humorous fractures[J].Techn Shoulder Elbow Surge,2006,1:44-51
[25] Doorn berg JN, Duijn PJ,Unzel D,etal. Surgical treatment of intra-particular fractures of the distal Part of the functional outcome after twelve to thirty years[J].J Bone Joint Surge (Am),2007,7:1524-1532
[26]张爽,李志伟.双钢板法治疗肱骨髁间骨折[J].中华骨科杂志,2005,25(l):49
[27] Mccartylp.Ring D.Jupiter JB. Management of distal humorous fractures [J]. Jorthop,2005,34(9):430-438
[28]袁天祥,马宝通,刘林涛,等.肱骨髁间骨折的手术疗效分析〔J〕.中国矫形外科杂志,2006,14(4):257-259
[29] Kundelk.braunw,wiebemej, etal. Intra-auricular distal humorous fractures: factor affecting functional outcome[J].Clinorthop,1996,332:200-205
[30]张安贞,等.中医骨伤学[M].人民卫生出版社,第二版,1998
[31]方先之,等.中西医结合治疗骨折[J].北京卫生出版社,1996
[32]尚天裕,等.中西医治疗骨折新法[J].骨科附刊,试刊号1978;8
[2]张殿英,姜保国,付中国,等.外固定支架在儿童骨折中的应用研究[J].中华创伤骨科杂志,2002,1:28-30.
[3]蒋协远,张力丹,刘兴华,等.可活动的铰链外固定架在肘部创伤治疗中的应用[J].中华外科杂志,2004,12:737-740.
[4] Pennig D, Gausepohl T, Mader K. Trans articular fixation with the capacity for motion in fracture dislocations of the elbow[J]. Injury,2000,1:35-44.
[5] Fornasieri C ,Staub C, Tourne Y, etal. Biomechanical comparative study of three types of synthesis in the treatment of supra and intercondylar fractures of the humerus in adults[J]. Rev Chir Orthop Reparatrice Appar Mot,1997,3:237-242.
[6]许申明,白书臣,宋耀发,等.桡侧张力带结合拉力螺钉内固定治疗肱骨髁间骨折[J].中国矫形外科杂志,2003,11(24):1716,1717.
[7] Allende C A, Allende B T, Allende B L, et al. Intercondylar distal humerus fractures surgical treatment and results[J]. Chir Main, 2004, 2:85-95.
[8]卢华定,蔡道章,金文涛,等. AO双钢板内固定治疗肱骨髁间骨折[J].中国矫形外科杂志,2008,3:408-410.
[9] Helfet DL, Hotchkiss RN. Interal fixation of the distal humerus :a biomechanical comparison of methods[J].J Orthop Trauma,1990,4:260.
[10] Eralp L, Kocaoglu M,Sar C,et al. Surgical treatment of distal intra articular humeral fractures in adults[J].Iht Orthop,2001,25:46-50.
[11] Yang KH, Park HW, Park SJ, etal. Lateral J , plate fixation in comminuted inter-condylar fracture of the humorous[J].Arch Northrop Trauma Surg,2003,123:234-238.
[12]卢世璧主译.坎贝尔骨科学.北京:人民军医出版社,2008,第九版;688
[13]胥少汀,葛宝丰,徐印坎主编.实用骨科学.北京:人民军医出版社,2005,第3版;466
[14]王亦璁主编.骨与关节损伤[M].北京:人民卫生出版社,2007;第四版325
[15]方先之,等.中西医结合治疗骨折[J].北京卫生出版社,1996
[16]尚天裕,等.中西医治疗骨折新法[J].骨科附刊,试刊号1978;8
[1]张磊,原林,戴景兴等肱骨髁间骨折3种内固定的生物力学比较[J].解放军医学杂志,2005,30(4):339-341
[2]黄雷,张波,王满宜,等.肱骨髁间骨折的手术治疗[J].中华骨科杂志,2001 21(3):158-162
[3]丁卫华,刘明.经鹰嘴截骨肘后入路显露方式的探讨[J].中华骨科杂志,2000,20:508-509
[4]苗全顺.肱骨髁间骨折不同手术入路64例疗效分析[J].中国药物与临床,2007,7(4):304
[5]沈国平,彭水岳,毛汉兴,等.肱骨髁间骨折的手术治疗[J].中医正骨,2005,17(6):47
[6]吴英华,张铁良,金硕,等.经尺骨鹰嘴关节外斜形截骨治疗肱骨髁间骨折[J].中华骨科杂志,2005,8:472-475
[7]明立功,明新月,明新杰,等.经尺骨鹰嘴截骨治疗肱骨髁间C型骨折[J].中国骨与关节损伤杂志,2007,22(7):567-569
[8] Man ueddua,hoffmeyer,haluickym,etal. Distal humeral fracture In adults : functional evaluation and measurement of isometric strength[J].Rev Chirortho Prepara triee Appar Mot,1997,83(6):551-560
[9] Schild hauerta, norkse, miuswj, etal. Extensor mechanism-sparing Paretic Petal posteriori Praetor the distal humorous[J] .Jortho Trauma,2003,17(5):374-378
[10] Mckeemd, wilstont, etal﹒ Fractional outcome following Surgical treatment of intra- articular distal humeral factures through posterior Propane[J].Bone Joint Surg(Am),2008,2(12):1701-1707
[11]川朱利军,江开良,杨林,等.经肱三头肌两侧入路AO重建钢板内固定治疗肱骨髁间骨折[J].中华创伤骨科杂志,2006,8(6):577
[12]黄令坚,黄春福,王鸿太,等.多切口入路结合多块钢板固定治疗肱骨髁间骨折[J].中国骨与关节损伤杂志,2007,22(4):315-316
[13]张秋林,赵杰,王家林,等.肱骨远端关节内粉碎性骨折的内固定治疗[J].中国矫形外科杂志,2001,8(4):342-344
[14]王友华,刘瑶,周振宇,等.三种内固定方法治疗肱骨髁间粉碎性骨折的疗效比较[J].中华创伤骨科杂志,2006,8(8)701-705
[15] Driscollsw.optimizing stability in distal humeral fracture fixation[J]. J Shoulder Elbow Surg,2005,14(Suppl S):186S-194S
[16] Elhager,Maynouc, Jugnetpm, etal. long term results of the surgical Treatment of bieondylar fractures of the distal humorous extremity in adults[J].Charmin,2001,20(2):144-154
[17] Guptar,khanchandanip Intercondylar fractures of the distal humorous in adults: critical analysis of 55 eases[Jury,2002,33(6):511-515
[18] Komer ,Diederichs G,Jzdorf M, etal. A biomechanical evaluation of methods of distal humorous fracture fixation using locking compression Plate versus conve- ntional Reconstruction Plates [J].Jortho P Trauma,2004,18:286-293
[19] RuehDS, TriePel CR.Hinged elbow fixation for recurrent instability following Fracture dislocation [J].Injury,2001,32(4):70
[20] Frankle MA,Hersovieid JR, DI pasquale TG, etal·A comparison of open reduction And internal fixation and Primary total elbow arthroplasty in the treatment of intra- articular distal Humorous fractures in women older than age65 [J].JorthoPTrauma,2003,17:473-480
[21]王盛,孙铭,吕庆生.经尺骨鹰嘴关节外截骨应用解剖钛钢板治疗肱骨远端骨折[J].中国现代医学杂志,2007,1716:2032-2034
[22] Eralpl,Kocaoglu M,Sar C,etal. Surgical treatment of distal intra-ocular humeral Fractures in adults[J].orthop,2001,25:46-50
[23] Huang TL,Chiu FY,Chuang TY,etal. The results of open reduction and intimae Fixation in elderly Patients with severe fractures of the distal humorous :article analysis of the results[J].J Trauma,2005,58:62-69
[24] Ramseyml, Bratieak,Getzcl. open reduction and intimae fixation of distal Humorous fractures[J].Techn Shoulder Elbow Surge,2006,1:44-51
[25] Doorn berg JN, Duijn PJ,Unzel D,etal. Surgical treatment of intra-particular fractures of the distal Part of the functional outcome after twelve to thirty years[J].J Bone Joint Surge (Am),2007,7:1524-1532
[26]张爽,李志伟.双钢板法治疗肱骨髁间骨折[J].中华骨科杂志,2005,25(l):49
[27] Mccartylp.Ring D.Jupiter JB. Management of distal humorous fractures [J]. Jorthop,2005,34(9):430-438
[28]袁天祥,马宝通,刘林涛,等.肱骨髁间骨折的手术疗效分析〔J〕.中国矫形外科杂志,2006,14(4):257-259
[29] Kundelk.braunw,wiebemej, etal. Intra-auricular distal humorous fractures: factor affecting functional outcome[J].Clinorthop,1996,332:200-205
[30]张安贞,等.中医骨伤学[M].人民卫生出版社,第二版,1998
[31]方先之,等.中西医结合治疗骨折[J].北京卫生出版社,1996
[32]尚天裕,等.中西医治疗骨折新法[J].骨科附刊,试刊号1978;8