蒙医传统整骨手法与切开复位钢板内固定治疗肱骨外科颈骨折的临床疗效观察

Clinical Efficacy Observation on Traditional Mongolian Medicine Osteopathic Manipulation and Open Reduction and Plate Internal Fixation for the Treatment of Humeral Surgical Neck Fractures

摘要: 目的：蒙医传统整骨手法复位小夹板固定与切开复位钢板内固定治疗肱骨外科颈骨折安全性与临床疗效。方法：分析2017年1月~2023年1月在该院住院治疗，经临床及X线检查明确诊断为肱骨外科颈骨折患者40例，其中传统蒙医整骨手法治疗组20例，对照组(切开复位钢板内固定治疗组)20例，经诊断为肱骨外科颈骨折患者。治疗组采用蒙医传统整骨手法进行复位、小夹板固定和喷酒按摩，而对照组则实施了切开复位钢板内固定(cutting reposition)。比较两组患者治疗3个月的Neer评分，6个月后Neer分数，以及合并症发生的时间。结果：蒙医传统整骨手法复位小夹板固定组骨折愈合时间较切开复位钢板内固定组短(P > 0.05)，蒙医传统的整骨手法复位小夹板固定组骨折愈合时间较切开复位钢板内固定组缩短，蒙医传统整骨手法复位小夹板固定组骨折愈合时间为短，蒙医药传统整骨术复位小夹板固定的组骨折痊愈时间为短。两组病人经过3个月的治疗，均有连续性骨痂形成，骨折线模糊，骨折已愈合。此时，治疗组的 Neer评分比对照组低(P < 0.05)，主要表现在功能、运动范围和解剖恢复等方面都比对照组差(P < 0.05)。两组患者的Neer评分在治疗后6个月内没有显著性差异(P > 0.05)。两组患者合并发生率(P > 0.05)无明显差异。结论：切开复位钢板内固定术优于蒙医传统整骨手法中的复位小夹板固定术，在骨折愈合的3个月内，尤其是肩关节功能和活动能力的恢复。然而，6个月后，两者在肩关节功能恢复方面差异不大。蒙医传统整骨手法结合多层小夹板外固定术，方法简单、不开刀、不留瘢痕、周围血管神经损伤风险低、费用低廉等优势，深受患者青睐，适合推广应用。

Abstract: Objective: To compare the safety and clinical efficacy of traditional Mongolian medicine osteopathic manipulation reduction with small splint fixation and open reduction and plate internal fixation in the treatment of humeral surgical neck fractures. Methods: 40 patients who were hospitalized in our hospital from January 2017 to January 2023 and were clearly diagnosed as having humeral surgical neck fractures through clinical and X-ray examinations were analyzed. Among them, 20 cases were in the traditional Mongolian medicine osteopathic manipulation treatment group, and 20 cases were in the control group (open reduction and plate internal fixation treatment group). The treatment group adopted traditional Mongolian medicine osteopathic manipulation reduction, small splint fixation, and liquor spraying massage, while the control group implemented open reduction and plate internal fixation. The Neer scores at 3 months and 6 months after treatment and the occurrence of complications were compared between the two groups. Results: The fracture healing time of the group with traditional Mongolian orthopedic manipulation reduction and small splint fixation was shorter than that of the group with open reduction and plate internal fixation (P > 0.05). The fracture healing time of the group with traditional Mongolian orthopedic manipulation reduction and small splint fixation was shorter. After 3 months of treatment, both groups of patients had continuous callus formation, the fracture lines were blurred, and the fractures had healed. At this time, the Neer score of the treatment group was lower than that of the control group (P < 0.05), mainly manifested as worse function, range of motion, and anatomical recovery compared with the control group (P < 0.05). There was no significant difference in the Neer scores of the two groups of patients within 6 months after treatment (P > 0.05). There was no obvious difference in the complication incidence rate between the two groups of patients (P > 0.05). Conclusion: Within 3 months of fracture healing, the open reduction and plate internal fixation method is superior to the traditional Mongolian medicine osteopathic manipulation reduction with small splint fixation method, especially in the recovery of shoulder joint function and mobility. However, after 6 months, there is little difference between the two methods in terms of shoulder joint function recovery. The traditional Mongolian medicine osteopathic manipulation combined with multi-layer small splint external fixation has the advantages of simple method, no need for surgery, no scar left, low risk of peripheral vascular and nerve injury, and low cost, etc., which is favored by patients and is suitable for popularization and application.