[精品]手术结合自拟通络活血汤治疗肱骨小头骨折的临床研究.doc

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1、手术结合自拟通络活血汤治疗肱骨小头骨折的临床研究手术结合自拟通络活血汤治疗肱骨小头骨折的临床研究【摘耍】目的探讨采用手术治疗结合自拟通络活血汤内服治疗肱骨小头骨折的疗效研究。方法2005年1月至2011年1月，采用肘窝形入路直视下复位骨折，分别于肱骨小头、滑车由前向后置入螺钉固定治疗肱骨小头骨折11例。男9例，女2例;年龄为14〜18岁，平均15岁；左侧7例，右侧4例。其屮7例曾在外院行手法复位失败。所有患者均为新鲜闭合性骨折，无神经、血管损伤。手术时间为伤后3〜7d,按王亦理'等的分型均为I型（完全型）肱骨小头滑车骨折,术后内服自拟通络活血汤。结论（1）肱骨小头骨折为囊内骨折

2、，移位的肱骨小头-滑车骨块不与肌肉、关节囊相连，无血液供应，远期有发生缺血坏死的可能。（2）肱骨小头骨折复位受到关节囊破裂口的阻挡,徒手整复很难成功，应行切开复位内固定术。手术应达到解剖复位和牢固固定，以降低肱骨小头-滑车骨块远期缺血坏死的发生率。（3）手术宜采用肘窝S形入路，可在直视下暴露骨折面和骨折块，能够准确地进行复位和固定,术后内服自拟通络活血汤可早期行肘关节主动伸屈功能锻炼，近期疗效较佳。【关键词】肱骨骨折肘窝s形入路自拟通络活血汤中图分类号：R683文献标识码:B文章编号:1005-0515（2011）12-121-01[Abstract】ObjectiveToin

3、vestig&tetheuseofsurgerycombinedwithselfTongluoDecoctionOraltreatmentofhumeralheadfracturesinthestudy.MethodsfromJanuary2005toJanuary2011,theuseofthecubitalfossa〃S"一shapedfracturereductionunderdirectvisionintotheroad,wereonthehumeralhead,tacklefromfronttobackintothescrewfixationofhumeralhead

4、fracturesin11cases・9malesand2females:aged14to18years,mean15years;theleftsidein7cases,therightsidein4cases・7caseshavebeenoutsidethehospitalmanualreductionfa订ed・Allpatientswerefreshclosedfracture,nonerve,vasculardamage.Surgerytimeafterinjury3~7d,accordingtoWANGYiheldsuchtypeareI(completetype)f

5、racturesofthehumeralheadpulley,afteroraladministrationofselfTongluoDecoction.Conclusions(1)humeralheadfracturesasintracapsularfracture,displacementofthehumeralhead-donottackleboneandmuscle,jointcapsuleattached,nobloodsupply,long-termischemicnecrosismayoccur.(2)humeralheadfracturesbyblockingt

6、hemouthofthejointcapsulerupture,difficulttohandthesuccessoftheentirecomplexshouldopenreductionandinternalfixation.Surgeryshouldbetoachieveanatomicreductionandfirmlyfixedtoreducethehumeralhead-tacklelong-termbonenecrosisincidence・⑶theuseofthecubitalfossasurgeryshouldbeS-shapedapproach,underdi

7、rectvisioncanbeexposedtothefracturesurfaceandfractureblockthatcanbeaccuratelyreductionandfixation,afteroraladministrationofselfTongluoDecoctionandearlyactiveelbowflexionlinefunctionaltraining,short-termeffectbetter・[Keywords】humeralfracturess-shape