動(dòng)靜平衡原則對(duì)小兒肱骨髁上骨折術(shù)后關(guān)節(jié)功能恢復(fù)的影響

程鑫++張琴飛

[摘要] 目的 探討動(dòng)靜平衡原則對(duì)小兒肱骨髁上骨折術(shù)后關(guān)節(jié)功能恢復(fù)的影響。 方法 選擇2015年2月～2016年8月上海中醫(yī)藥大學(xué)附屬曙光醫(yī)院收治的肱骨髁上骨折患兒72例，均實(shí)施切開復(fù)位經(jīng)皮克氏針固定術(shù)治療。將所有患兒根據(jù)隨機(jī)數(shù)字表法分為兩組，每組各36例。實(shí)驗(yàn)組根據(jù)動(dòng)靜平衡原則實(shí)施功能康復(fù)鍛煉，對(duì)照組根據(jù)傳統(tǒng)功能康復(fù)原則實(shí)施功能鍛煉。記錄兩組患兒骨折功能康復(fù)時(shí)間、肘關(guān)節(jié)屈伸活動(dòng)角度、術(shù)后2周疼痛程度[視覺模擬評(píng)分法（VAS）、兒童疼痛行為量表（FLACC）]、術(shù)后12周肘關(guān)節(jié)功能康復(fù)情況以及并發(fā)癥發(fā)生情況。 結(jié)果 實(shí)驗(yàn)組中骨折功能康復(fù)時(shí)間顯著短于對(duì)照組，肘關(guān)節(jié)屈伸活動(dòng)角度大于對(duì)照組，差異有高度統(tǒng)計(jì)學(xué)意義（P < 0.01）；實(shí)驗(yàn)組中肘關(guān)節(jié)功能康復(fù)優(yōu)良率為97.22%（35/36）顯著高于對(duì)照組的80.56%（29/36），差異有統(tǒng)計(jì)學(xué)意義（P < 0.05）；術(shù)后2周實(shí)驗(yàn)組VAS、FLACC評(píng)分均低于對(duì)照組，差異有高度統(tǒng)計(jì)學(xué)意義（P < 0.01）；對(duì)照組并發(fā)癥發(fā)生率高于實(shí)驗(yàn)組，但比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P > 0.05）。 結(jié)論 對(duì)小兒肱骨髁上骨折術(shù)后根據(jù)動(dòng)靜平衡原則實(shí)施功能鍛煉，能有效縮短骨折功能康復(fù)時(shí)間、促進(jìn)肘關(guān)節(jié)功能康復(fù)，增大肘關(guān)節(jié)屈伸活動(dòng)角度，降低患者術(shù)后疼痛程度，減少并發(fā)癥發(fā)生，安全性較高。

[關(guān)鍵詞] 動(dòng)靜平衡原則；小兒；肱骨髁上骨折；關(guān)節(jié)功能

[中圖分類號(hào)] R683.41 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1673-7210（2017）11（c）-0114-04

Effect of dynamic-static equilibrium principle on postoperative recovery of joint function in children with supracondylar fracture of humerus

CHENG Xin ZHANG Qinfei

Department of Tramotology and Orthopedics， Affiliated Shuguang Hospital of Shanghai University of Traditional Chinese Medicine， Shanghai 200021， China

[Abstract] Objective To investigate the effect of dynamic-static equilibrium principle on postoperative recovery of joint function in children with supracondylar fracture of humerus （SFH）. Methods 72 SFH children in our hospital from February 2015 to August 2016 were selected， and they were treated with open reduction and percutaneous Kirschner internal fixation. All the children were divided into two groups by random number table， 36 cases in each group. Experimental group was given functional rehabilitation based on dynamic-static equilibrium principle， while control group was given functional rehabilitation based on traditional rehabilitation principle. The rehabilitation time of fracture， flexion-extension angle of elbow joint， postoperative two-week pain degree [visual analogue scale score （VAS）， the face， legs， activity， cry， consolability behavioral tool （FLACC）]， postoperative twelve-week rehabilitation of elbow joint， complications in two groups were recorded. Results The rehabilitation time of fracture in experimental group was shorter than control group， while the flexion-extension angle of elbow joint was larger than control group， the differences were statistically significant （P < 0.01）； the excellent rate of rehabilitation of elbow joint in experimental group was 97.22% （35/36）， which was higher than 80.56% （29/36） in control group， the differences were statistically significant （P < 0.05）； after surgery for two weeks， the scores of VAS， FLACC in experimental group were lower than control group， the differences were statistically significant （P < 0.01）； the incidence of complications in control group was higher than that in experimental group， but there was no statistical difference （P > 0.05）. Conclusion Functional exercise based on dynamic-static equilibrium principle for SFH children can shorten the rehabilitation time of fracture， promote recovery of elbow joint， enlarge the flexion-extension angle of elbow joint， decrease postoperative pain， reduce complications and have higher safety.endprint

[Key words] Dynamic-static equilibrium principle； Children； Supracondylar fracture of humerus； Joint function

肱骨髁上骨折為臨床常見的骨折類型之一，好發(fā)于3～12歲兒童。肱骨髁上骨折的發(fā)病率在肘關(guān)節(jié)損傷中占60%～70%，在兒童全身骨折中約占26.8%[1]。手術(shù)是治療肱骨髁上骨折的常用手段，臨床治療的最終目標(biāo)為骨折愈合后的功能康復(fù)，其能減少或避免患兒術(shù)后肌肉萎縮、關(guān)節(jié)僵硬、骨折不愈合或延遲愈合等并發(fā)癥的發(fā)生[2]。但因兒童自律性欠佳，其術(shù)后難以及時(shí)、有效地實(shí)施康復(fù)訓(xùn)練，部分患兒術(shù)后伴有肘關(guān)節(jié)屈伸活動(dòng)受限等后遺癥[3]。……