Full text in thai

«‘™“°“√
Comparative study of two devices management of diaphysis
humeral shaft fracture : Functional slab and U-slab)
Tawatchai Amornmorakot., MD.
Division of Orthopedics, Roi-et hospital.
Abstract
Non-surgical management of humeral shaft fractures had many effective devices. But result loss of motion
of motion of shoulder and elbow joint from prolong immobilize them. The purpose of this study was to evaluate of
healing time and functional outcome between Functional slab and U-slab.
Fifty humeral shaft fracture were enter in to the trial. The study was conducted in two group of patients one
group received management by Functional slab while another group was management by U-slab. The result was
analyzed using the independent T test Mean Median Mode SD. Result in the study, in Functional slab group and U-slab
group were no significant different of healing time but functional outcome of shoulder and elbow joint were significant.
In this type of Functional slab improve the extremity is accessible for hygiene andearly function can be instituted.
Keywords : Humeral shaft fracture.
MAHASARAKHAM HOSPITAL JOURNAL
Vol. 8 No. 1 May - July 2011
11
°“√»÷°…“‡ª√’¬∫‡∑’¬∫º≈°“√√—°…“°√–¥Ÿ°µâπ·¢πÀ—°
¥â«¬ Functional slab ·≈– U-slab
∏«—™™—¬ Õ¡√¡√°µ., æ.∫.
°≈ÿà¡ß“πÕÕ√å‚∏ªî¥‘° å ‚√ß欓∫“≈√âÕ¬‡ÕÁ¥
∫∑§—¥¬àÕ
°“√»÷°…“‡ª√’¬∫‡∑’¬∫º≈°“√√—°…“°√–¥Ÿ°µâπ·¢πÀ—°¥â«¬ Functional slab ·≈– U-slab ‡ªìπ°“√»÷°…“«‘®—¬‡™‘ß
∑¥≈Õß (Experimental research) ·≈–«‘‡§√“–Àåº≈∑“ß ∂‘µ‘‚¥¬„™â‚ª√·°√¡ ”‡√Á®√Ÿª ¡’«—µ∂ÿª√– ß§å ‡æ◊ËÕª√–‡¡‘πº≈°“√
√—°…“°√–¥Ÿ°µâπ·¢πÀ—° (Humeral shaft fracture) ¥â«¬«‘∏’ Functional slab ·≈– U-slab «à“¡’º≈°“√√—°…“¢Õß∑—Èß 2 «‘∏’
·µ°µà“ß°—πÀ√◊Õ‰¡à
°“√√—°…“°√–¥Ÿ°µâπ·¢πÀ—°‚¥¬‰¡àºà“µ—¥¡’À≈“¬«‘∏’ ´÷Ëß¡—°æ∫¢âÕ»Õ°À√◊Õ¢âÕ‰À≈൑¥¿“¬À≈—ß°“√√—°…“‡æ√“–
·¢π‰¡à¡’°“√‡§≈◊ËÕπ‰À«‡ªìπ√–¬–‡«≈“π“π ®÷ß∑”°“√»÷°…“‡ª√’¬∫‡∑’¬∫Õ—µ√“°“√µ‘¥¢Õß°√–¥Ÿ° (Healing rate) °“√
‡§≈◊ÕË π‰À«¢ÕߢâÕ»Õ°·≈–¢âÕ‰À≈à (Functional outcome) ·≈–√–¥—∫§«“¡æ÷ßæÕ„®µàÕ°“√„ à‡ΩóÕ° „πºŸªâ «É ¬°√–¥Ÿ°µâπ·¢πÀ—°
2 °≈ÿà¡ ‚¥¬»÷°…“°≈ÿà¡≈– 25 §π ∑’Ë¡“√—∫°“√√—°…“∑’Ë‚√ß欓∫“≈√âÕ¬‡ÕÁ¥ ‚¥¬„™â«‘∏’ U-slap À√◊Õ Functional slab ‡ªìπ°“√
»÷°…“«‘®—¬‡™‘ß∑¥≈Õß (Experimental research) ·≈–«‘‡§√“–Àåº≈∑“ß ∂‘µ‘‚¥¬„™â‚ª√·°√¡ ”‡√Á®√Ÿª ®“°º≈°“√»÷°…“
æ∫Õ—µ√“°“√µ‘¥¢Õß°√–¥Ÿ°∑—Èß 2 °≈ÿà¡ ‰¡à·µ°µà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ ·µàæ∫«à“Õ—µ√“°“√‡§≈◊ËÕπ‰À«¢Õß
¢âÕ»Õ°·≈–¢âÕ‰À≈à¢Õß°“√„ à functional slab ¥’°«à“«‘∏’°“√√—°…“‚¥¬ U-slap Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ ·≈–°≈ÿà¡∑’Ë„ à
Functional slab ¡’ functional outcome ¥’°«à“ ºŸâªÉ«¬¡’√–¥—∫§«“¡æ÷ßæÕ„®¡“°°«à“ ·≈– “¡“√∂¥Ÿ·≈√—°…“§«“¡ –Õ“¥
∫√‘‡«≥µâπ·¢π‰¥âßà“¬°«à“
§” ”§—≠ : °√–¥Ÿ°µâπ·¢πÀ—°, °“√√—°…“
12
«“√ “√‚√ß欓∫“≈¡À“ “√§“¡
ªï∑’Ë 8 ©∫—∫∑’Ë 1 情¿“§¡ - °√°Æ“§¡ 2554
∫∑π”
°√–¥Ÿ°µâπ·¢πÀ—° (Humeral shaft Fracture) æ∫‰¥â
ª√–¡“≥ 1% ¢Õß°√–¥Ÿ°À—°∑—ÈßÀ¡¥∑—Ë«√à“ß°“¬ ‡ªìπ
µ”·Àπàß∑’Ëæ∫‰¡à∫àÕ¬π—°1 ¢Õ∫‡¢µ¢Õß humeral shaft Õ¬Ÿà
√–À«à“ß superior border pectoralis major insertion °—∫
∫√‘‡«≥‡Àπ◊ÕµàÕ supracondylar ridge humerus2,3 ª°µ‘
∫√‘‡«≥µâπ·¢π¡’‡ âπ‡≈◊Õ¥¡“‡≈’Ȭ߮”π«π¡“° ¥—ßπ—Èπ °“√
À—°∫√‘‡«≥π’È ∑”„Àâ¡’°“√µ‘¥¢Õß°√–¥Ÿ°§àÕπ¢â“߇√Á« (Healing
rate) ‰¡à§Õà ¬æ∫«à“¡’ª≠
í À“ infection ·≈–‰¡à§Õà ¬æ∫°√–¥Ÿ°
4
‰¡àµ¥‘ (non-union) ·µà°¬Á ß— ¡’¿“«–·∑√°´âÕπ (complication)
∫“ßÕ¬à“ß ‡™àπ radial nerve paralysis —¡æ—π∏å°—∫°“√À—°
∫√‘‡«≥µâπ·¢π à«π≈à“ß (lower third Humerus) æ∫Õ—µ√“
°“√‡°‘¥Õ¬Ÿà∑’Ë 1-2%5,6 ¢Õß°√–¥Ÿ°µâπ·¢πÀ—° à«π¿“«–
°√–¥Ÿ°‰¡àµ‘¥ (non-union) Õ—µ√“‡°‘¥Õ¬Ÿà√–À«à“ß 8-15%7 „π
¿“«–8°“√√—°…“ à«π„À≠à ®–‡ªìπ°“√√—°…“·∫∫‰¡àµâÕß
ºà“µ—¥ (non-operative Treatment)8,9 ´÷Ë߉¥âº≈°“√√—°…“∑’Ë¥’
∑—Èß„π·ßà°√–¥Ÿ°µ‘¥‡√Á« ·≈–¿“«–·∑√°´âÕππâÕ¬°«à“°“√
√—°…“‚¥¬«‘∏’ºà“µ—¥ °“√√—°…“·∫∫‰¡àµâÕßºà“µ—¥ ¡’À≈“¬«‘∏’
∑’Ë„™âÕ¬Ÿà„πªí®®ÿ∫—𠇙àπ Coaptation splint, Hanging cast
À√◊Õ Velpeau bandage10 ´÷Ëß·µà≈–«‘∏’„π°“√√—°…“ ºŸâªÉ«¬
µâÕßÕ¬Ÿà„π∑à“∑’ˉ¡à¡’°“√‡§≈◊ËÕπ‰À« (Immobilization) ‡ªìπ
√–¬–‡«≈“π“π ∑”„ÀâÀ≈—ß°“√√—°…“‡°‘¥Õ“°“√¢âÕ‰À≈൑¥
(adhesive capsulitis) À√◊Õ¡’¿“«–¢âÕ»Õ°µ‘¥ (stiff elbow) ´÷Ëß
Õ“®®”‡ªìπµâÕßÕ“»—¬°“√∑”°“¬¿“æ∫”∫—¥À≈—ß°“√√—°…“
¥—ßπ—Èπ °“√„™â Functional brace ®÷߇ªìπÕ’°∑“߇≈◊Õ°Àπ÷Ëß
„π°“√√—°…“ ‡æ√“–¡’√“¬ß“π«à“∑Ì“„Àâ°“√µ‘¥¢Õß°√–¥Ÿ°
‡√Á«¢÷Èπ ·≈–¡’º≈°“√√—°…“∑’Ë¥’ (good functional result)11,12,13
‡π◊Ë Õ ß®“°„πªí ® ®ÿ ∫— π °“√√— ° …“°√–¥Ÿ ° µâ π ·¢πÀ— ° „π
‚√ß欓∫“≈√âÕ¬‡ÕÁ¥ ·∫∫‰¡àºà“µ—¥ (non-operative Treatment) ®–„™â«‘∏’°“√√—°…“·∫∫„ à U-slab À√◊Õ Hanging cast
´÷ËߺŸâªÉ«¬µâÕßÕ¬Ÿà„π∑à“π‘Ëß Ê (immobilization) ‡ªìπ‡«≈“π“π
À≈—ß°“√√—°…“ºŸâªÉ«¬ºŸâªÉ«¬¡—°¡’ªí≠À“¢âÕ‰À≈à·≈–¢âÕ»Õ°
µ‘¥ ∑”„Àâº≈°“√√—°…“ ‰¡à‡ªìπ∑’Ëπà“æÕ„®¢ÕߺŸâªÉ«¬ ¥—ßπ—Èπ
„π°“√»÷°…“π’®È ß÷ „™â Functional slab ‡ªìπÕ’°·π«∑“߇≈◊Õ°Àπ÷ßË
„π°“√√—°…“ ºŸâªÉ«¬‰¥â√—∫§«“¡ –¥«° ∫“¬ “¡“√∂ ¥Ÿ·≈
√—°…“§«“¡ –Õ“¥¢Õßµâπ·¢π‰¥âßà“¬
«—µ∂ÿª√– ߧå
‡æ◊ÕË ª√–‡¡‘πº≈°“√√—°…“°√–¥Ÿ°µâπ·¢πÀ—° (Humeral
shaft fracture) ¥â«¬«‘∏’ Functional slab ·≈– U-slab «à“¡’
º≈°“√√—°…“¢Õß∑—Èß 2 «‘∏’·µ°µà“ß°—πÀ√◊Õ‰¡à
ª√–‚¬™πå∑’˧“¥«à“®–‰¥â√—∫
°“√√—°…“‚¥¬«‘∏’°“√ Functional slab πà“®–‰¥âº≈°“√
√—°…“¥’°«à“ U-slab „π·ßà¢Õß Healing rate ·≈– Function
outcome ºŸâªÉ«¬ “¡“√∂‡§≈◊ËÕπ‰À«·¢π‰¥â¥’°«à“ –¥«°
∫“¬°«à“ “¡“√∂¥Ÿ·≈µâπ·¢π‰¥â¥’°«à“°“√„ à U-slab
«‘∏’°“√»÷°…“
ºŸªâ «É ¬∑’‡Ë ªìπ°√–¥Ÿ°µâπ·¢πÀ—° (Humeral shaft fracture)
∑’Ë¡“∑”°“√√—°…“∑’Ë‚√ß欓∫“≈√âÕ¬‡ÕÁ¥ „π√–À«à“߇¥◊Õπ
¡°√“§¡ 2551-情¿“§¡ 2553 ‚¥¬„™â°“√√—°…“ 2 ·∫∫
§◊Õ
«‘∏’∑’Ë 1 „™â°“√√—°…“ U-slab µ≈Õ¥°“√√—°…“
«‘∏’∑’Ë 2 „™â U-slab ª√–¡“≥ 1-2 Õ“∑‘µ¬å ‡æ◊ËÕ≈¥∫«¡
µàÕ®“°π—Èπ‡ª≈’ˬπ‡ªìπ„™â Functional slab µ≈Õ¥°“√√—°…“
‡°≥±å°“√§—¥‡≈◊Õ°ª√–™“°√°≈ÿ¡à µ—«Õ¬à“ß (Inclusion
criteria)
ºŸâªÉ«¬∑’ˇªìπ°√–¥Ÿ°µâπ·¢π (Humeral shaft fracture)
∑’Ë ¡ “∑”°“√√— ° …“∑’Ë ‚ √ß欓∫“≈√â Õ ¬‡ÕÁ ¥ µ—È ß ·µà ‡ ¥◊ Õ π
¡°√“§¡ 2551- 情¿“§¡ 2553
‡°≥±å°“√§—¥ÕÕ° (Exclusion criteria)
ºŸâªÉ«¬°√–¥Ÿ°µâπ·¢π (Humeral shaft fracture) ∑’Ë
√—°…“·∫∫°“√ºà“µ—¥ Õ—π‡π◊ËÕß¡“®“°
- multiple injury
- segmental fracture humerus
- Non-union or (> 6 mo)
- Inadequate reduction
MAHASARAKHAM HOSPITAL JOURNAL
Vol. 8 No. 1 May - July 2011
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°“√√«∫√«¡¢âÕ¡Ÿ≈
°≈ÿࡵ—«Õ¬à“ß¡’ 50 §π ‚¥¬·∫à߇ªìπ 2 °≈ÿà¡ °≈ÿà¡≈–
25 §π
°≈ÿà¡∑’Ë 1 Õ“¬ÿ‡©≈’ˬ 36.45 ªï ‡ªìπ‡æ»À≠‘ß 7 §π
‡æ»™“¬ 18 §π ¡“æ∫·æ∑¬å§√—Èß·√°∑’Ë‚√ß欓∫“≈√âÕ¬‡ÕÁ¥
‰¥â√—∫°“√√—°…“‚¥¬«‘∏’ Closed reduction ·≈–„ à U-slab
°≈—∫∫â“π ®“°π—È𵑥µ“¡º≈°“√√—°…“∑ÿ° 2 —ª¥“Àå ®π
°√–∑—Ëß ‘Èπ ÿ¥°“√√—°…“
°≈ÿà¡∑’Ë 2 Õ“¬ÿ‡©≈’ˬ 35.9 ªï ‡ªìπ‡æ»À≠‘ß 6 §π
‡æ»™“¬ 19 §π ¡“æ∫·æ∑¬å§√—Èß·√°‰¥â∑”°“√√—°…“‚¥¬
«‘∏’ Closed reduction ·≈–„ à U-slab °≈—∫∫â“π π—¥µ‘¥µ“¡
º≈°“√√—°…“ 1-2 —ª¥“Àå µàÕ¡“‡æ◊ËÕ„ÀâÕ“°“√∫«¡≈¥≈ß
·≈⫇ª≈’Ë¬π¡“„ à Functional slab ·∑π ®“°π—È𠵑¥µ“¡
º≈°“√√—°…“∑ÿ° 2 —ª¥“Àå®π°√–∑—Ëß ‘Èπ ÿ¥°“√√—°…“
°“√ ÕπºŸâªÉ«¬ exercises À≈—ß®“°„ à Functional slab
·≈â«„À⺟âªÉ«¬∑” Pendulum exercise ·≈–Passive elbow
flexion and extension exercises ®“°π—Èππ—¥µ‘¥µ“¡º≈
°“√√—°…“ Õ’° 2 —ª¥“Àå ÕπºŸâªÉ«¬∑” Fully active elbow
flexion and extension exercises ‡æ◊ËÕ correct angulations
∫“ß à«π„À⥒¢÷Èπ ®“°π—Èππ—¥∑ÿ° 2 —ª¥“Àå ∑”°“√ x-ray ∂â“
‡√‘Ë¡æ∫«à“¡’ callus „Àâ ÕπºŸâªÉ«¬∑” Active flexion-abduction
shoulder ®π°√–∑—Èß°√–¥Ÿ°µ‘¥ ®÷߇Փ Functional slab ÕÕ°
Clinical ∑’Ë∂◊Õ«à“°√–¥Ÿ°µ‘¥4
1. ºŸâªÉ«¬ “¡“√∂¬°·¢π ¡“°∂÷ß 90 ‚¥¬‰¡àª«¥
2. film x-ray ¡’ sign of union
√Ÿª∑’Ë 1 Functional slap ¥â“πÀπâ“
√Ÿª∑’Ë 2 Functional slap ¥â“πÀ≈—ß
14
«“√ “√‚√ß欓∫“≈¡À“ “√§“¡
ªï∑’Ë 8 ©∫—∫∑’Ë 1 情¿“§¡ - °√°Æ“§¡ 2554
«‘∏’°“√∑” Functional slab
- „™â‡ΩóÕ°¢π“¥ 4 π‘È« æ—π√Õ∫µâπ·¢π „Àâ¡’§«“¡Àπ“
ª√–¡“≥ 8-10 ™—Èπ
- ¢Õ∫‡¢µ¥â“π„π¢Õßµâπ·¢π „Àâ¢Õ∫∫πÕ¬Ÿà„µâ√—°·√â
¢Õ∫≈à“ßÕ¬Ÿà‡Àπ◊ÕµàÕ medial epicondyle
- ¢Õ∫‡¢µ¥â“ππÕ°¢Õßµâπ„Àâ¢Õ∫∫πÕ¬Ÿà∫√‘‡«≥
À—«‰À≈à¢Õ∫≈à“ßÕ¬Ÿà∫√‘‡«≥‡Àπ◊ÕµàÕ lateral epicondyle
- ≈Ÿ∫‡ΩóÕ°„À⇢â“√Ÿª ‚¥¬‡©æ“–¥â“π medio-lateral
‡æ◊ËÕ®—¥ varus-vagus angulations „À⥒¢÷Èπ
- √Õ‡ΩóÕ°·Àâß·≈⫵—¥‡ΩóÕ°ÕÕ°‡ªìπ 2 Ω“¥â“π ‚¥¬
„Àâ¡’√Õ∫Àà“ߢÕßΩ“Àà“ß°—π¥â“π≈– 1 ‡´πµ‘‡¡µ√
- ®“°π—Èπæ—π Elastic bandage √Õ∫‡ΩóÕ°„Àâ°√–™—∫
¥—ß√Ÿª 1 ·≈–√Ÿª 2
º≈°“√∑¥≈Õß
®“°°“√»÷°…“æ∫«à“°≈ÿࡵ—«Õ¬à“ß∑—Èß 2 °≈ÿà¡ ¡’
¢âÕ¡Ÿ≈æ◊Èπ∞“π∑’ˉ¡à·µ°µà“ß°—π∑—Èß∑“ߥâ“πÕ“¬ÿ ‡æ» ·≈–
µ”·Àπàß∑’ËÀ—°
1. ®“°º≈°“√«‘®—¬‡√◊ËÕßÕ—µ√“§«“¡‡√Á«„π°“√µ‘¥
¢Õß°√–¥Ÿ° æ∫«à“Õ—µ√“°“√µ‘¥¢Õß°√–¥Ÿ°∑—Èß 2 °≈ÿà¡ ‰¡à¡’
§«“¡·µ°µà“ß°—π∑“ß ∂‘µ‘ (P=0.603)
°≈ÿà¡ Functional slab ¡’§à“‡©≈’ˬ°“√µ‘¥∑’Ë 8.36
—ª¥“Àå (4-12 —ª¥“Àå)
°≈ÿà¡ U-slab ¡’§à“‡©≈’ˬ°“√µ‘¥∑’Ë 8.72 —ª¥“Àå
(4-12 —ª¥“Àå)
2. °“√«—¥¡ÿ¡∑’ˇ°‘¥¢÷Èπ ®“°¿“æ∂à“¬√—ß ’ À≈—ß®“°
°√–¥Ÿ°µ‘¥ ∑—Èß„π∑à“ AP ·≈–lateral view æ∫«à“‰¡à¡’§«“¡
·µ°µà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ ‚¥¬¡’§à“ P value =
0.720
3. °“√‡§≈◊ËÕπ‰À«À≈—ß®“°°√–¥Ÿ°µ‘¥ °≈ÿà¡ Functional slab ¡’°“√‡§≈◊ËÕπ‰À«¢Õ߉À≈à ·≈–¢âÕ»Õ°‰¥â¥’°«à“
°≈ÿà¡ U-slab Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ ‚¥¬¡’§à“ P value=
o.oo à«π‡§≈◊ËÕπ‰À«¢Õ߉À≈à·≈–¢âÕ»Õ° µ‘¥µ“¡º≈°“√
√—°…“À≈—ß∂Õ¥‡ΩóÕ°æ∫«à“∑—Èß 2 °≈ÿà¡ ¡’°“√‡§≈◊ËÕπ‰À«¥’¢÷Èπ
®“°À≈—ß∂Õ¥‡ΩóÕ°„À¡àÊ Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ ‚¥¬¡’
P value = 0.00 ·µà°≈ÿà¡ Functional slab °Á¬—ߧߡ’°“√
‡§≈◊ËÕπ‰À«∑’Ë¥’°«à“°≈ÿà¡ U-slab Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘
P value = 0.002
4. ‡¡◊ËÕ Õ∫∂“¡∂÷ߧ«“¡æ÷ßæÕ„®„π°“√„ à‡ΩóÕ°
æ∫«à“°≈ÿà¡∑’Ë„ à Functional slab ¡’§«“¡æ÷ßæÕ„®„π°“√
„ à‡ΩóÕ°¡“°°«à“°≈ÿà¡ U-slab Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘
P value = 0.00
√ÿªº≈°“√»÷°…“
°“√√—°…“ºŸªâ «É ¬°√–¥Ÿ°µâπ·¢πÀ—°‚¥¬«‘∏’ Functional
slab ∑”„Àâ¡’°“√‡§≈◊ËÕπ‰À« ¢âÕ»Õ° ·≈–¢âÕ‰À≈à ¥’°«à“
°“√√—°…“·∫∫ U-slab Õ¬à“ß¡’π—¬ ”§—≠ ∑“ß ∂‘µ‘ ·≈–
°≈ÿࡇªÑ“À¡“¬µà“ßæ÷ßæÕ„®°—∫°“√„ à Functional slab
¡“°°«à“°“√„ à U-slab
«‘®“√≥å
°“√»÷°…“§√—Èßπ’ȇªìπ°“√»÷°…“ ∂÷ߺ≈°“√√—°…“¢Õß
ºŸâªÉ«¬°√–¥Ÿ°µâπ·¢πÀ—°∑—Èß 2 «‘∏’ §◊Õ U-slab ·≈– Functional
slab ´÷Ëß∑—Èß 2 «‘∏’ ´÷Ëß∂◊Õ«à“‡ªìπ«‘∏’∑’ˉ¥â¡“µ√∞“π ·≈–‡ªìπ∑’Ë
¬Õ¡√—∫∑—Ë«‰ª ‚¥¬¡’®ÿ¥À¡“¬‡æ◊ËÕ„À⺟âªÉ«¬°≈—∫¡“„™âß“π
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Vol. 8 No. 1 May - July 2011
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