目的：探讨在常规治疗方案的基础上配合胸锁关节松动术对肱骨近端骨折术后肩关节功能障碍的康复疗效。方法：将40例肱骨近端骨折患者按随机数字表法分为2组，各20例。对照组采用常规治疗方案：盂肱关节松动术、超声波治疗、中药熏蒸、干扰电疗法，观察组在此基础上加入胸锁关节松动术。治疗前及治疗4周和8周后均采用Constant-Murley肩关节功能评分量表(Constant-Murley shoulder joint function assessment scale，CMS)、目测类比评分法(visual analogue score，VAS)及肩关节活动范围对患者的肩关节功能进行评定。结果：治疗4周及8周后，两组CMS总分评定显著高于治疗前，差异有统计学意义(P<0.05)。治疗4周后，观察组在日常活动(12.95±2.80)及关节活动范围(17.40±3.32)评分较对照组有显著差异，差异有统计学意义(P<0.05)。治疗8周后，观察组除疼痛评分外，在日常活动(14.70±3.79)、关节活动范围(22.10±4.38)及力量测试(15.30±2.94)评分较对照组，差异有统计学意义(P<0.05)。治疗8周后，两组在肩关节活动度及VAS评分上较治疗前均有显著提高，差异有统计学意义(P<0.05)。治疗4周后，两组肩关节前屈(108.20°±26.28°)、外展(78.35°±19.49°)及VAS评分(3.55±0.14)相比较，差异无统计学意义(P>0.05)。治疗8周后，观察组肩关节前屈(127.75°±25.30°)、外展(95.50°±16.93°)及VAS评分(2.05±0.15)明显高于对照组，差异有统计学意义(P<0.05)。结论：在常规治疗方案的基础上加用胸锁关节松动术可有效扩大肩关节活动范围，改善肩关节运动功能。
Sternoclavicular joint mobilization in the treatment of proximal humeral fracture of shoulder joint dysfunction
Objective: To study the postoperative rehabilitation efficacy of sternoclavicular joint mobilization of proximal humeral fractures based on conventional treatment on shoulder joint dysfunction. Methods: According to random number table method, 40 cases of postoperative patients of proximal humeral fractures were divided into an observation group and a control group (n=20). The control group obtained conventional rehabilitation treatment, which included joint mobilization, ultrasonic therapy, Chinese medicine fumigation, and interfere with the electrical treatment; the observation group were treated with the sternoclavicular joint mobilization on the basis of routine rehabilitation treatment. Before and 4 weeks and 8 weeks after treatment, Constant-Murley shoulder joint function assessment scale (CMS), visual analogue score (VAS) and the range of shoulder joint activity were used to evaluate the shoulder joint function of the patients. Results: After treatment for 4 weeks and 8 weeks, CMS score in both groups were significantly higher than those before treatment (P<0.05). Four weeks after treatment, the daily activities (12.95±2.80) and joint range (17.40±3.32 mm) in the observation group were significantly higher than those in the control group (P<0.05). Eitht weeks after treatment, except pain score, the daily activities (14.70±3.79), joint range (22.10±4.38) and strength test (15.30±2.94) in the observation group were significantly higher than that in the control group (P<0.05). Eight weeks after treatment, the shoulder joint activity and VAS score in both groups were significantly increased than those before treatment (P<0.05). Four weeks after treatment, shoulder joint proneness (108.2°±26.28°), outreach (78.35°±19.49°) and VAS (3.55°±0.14°) score had no significant changes from the previous (P>0.05). After 8 weeks treatment, shoulder joint flexion (127.75°±25.30°), outreach (95.50°±16.93°) and VAS (2.05±0.15) score in the the observation group were significantly higher than those in the control group (P<0.05). Conclusion: On the basis of routine rehabilitation treatment, the sternoclavicular joint mobilization can effectively improve the range of shoulder joint activities and the function of shoulder joint movement.