保守治疗与钛制弹性髓内钉治疗移位锁骨中段骨折的疗效对比分析  

Nonoperative treatment versus titanium elastic nailing for displaced midclavicular fractures

作　　者：陈云丰[1] 王磊[1] 敖荣广[1] 张长青[1] 罗从风[1] 曾炳芳[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华创伤骨科杂志》2009年第10期928-931,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 比较保守治疗与钛制弹性髓内钉（TEN）治疗明显移位锁骨中段骨折的疗效。方法回顾性研究2005年2月至2007年9月间采用保守治疗（保守治疗组，100例）或TEN固定（TEN固定组，60例）治疗并获得随访的160例移位锁骨中段骨折患者资料。比较两组患者术后的肩关节功能（Constant评分和DASH评分）、患者对治疗结果的满意度、恢复正常生活的时间、并发症发生率、肩部外观及锁骨愈合后的X线表现。结果所有患者术后获平均18个月（9～31个月）随访。保守治疗组和TEN固定组Constant评分分别为72．5分和90．5分（t=3．280，P=0．020），DASH评分分别为26．5分和2．4分（t=2．420，P=0．032）；满意率分别为75．0％和96．7％（r=1．450，P=0．042）；恢复正常生活时间分别为6～8周和2～3周；并发症发生率分别为13．0％和3．3％（r=1．890，P=0．020）。保守治疗组28例肩部不对称，42例解剖位置愈合。TEN固定组肩部基本对称，56例解剖位置愈合。结论TEN固定治疗移位的锁骨中段骨折，在肩部功能评分、满意率及并发症发生率等方面比保守治疗更有优势，因此不推荐使用保守治疗，TEN固定可作为一种有效的治疗方法。Objective To compare the therapeutic effects of nonoperative treatment and titanium elastic nailing （TEN） for displaced midclavicular fractures. Methods Included in this retrospective study were 160 cases of midclavicular fracture that had been treated from February 2005 to September 2007 by nonoperative treatment and by open reduction and internal fixation with TEN. The therapeutic effects were compared between the 2 groups in terms of postoperative shoulder function scores （Constant ＆ DASH）, satisfaction degrees of the patients, time needed for recovery to daily life, complications, appearance of shoulder, and X-ray manifestations after healing. Results The patients had a mean follow-up of 18 months（9 to 31 months） . In nonoperative treatment group： the mean Constant score was 72. 5 points and the mean DASH score was 26. 5 points eventually; the rate of satisfaction was 75.0% ; the time needed for recovery to daily life was 6 to 8 weeks; nonunion was found in 5 cases and symptomatic malunion in 8 cases, with a complication rate of 13.0% ; asymmetry of shoulder occurred in 28 cases; anatomical healing was found in 42 cases. In TEN group： the mean Constant score was 95 points （ t = 3. 280, P = 0. 020） and the mean DASH score was 2. 4 points （ t =2.420, P =0. 032） eventually; the rate of satisfaction was 96.7% （X^2= 1. 450, P =0. 042）; the time for recovery to daily life was 2 to 3 weeks; the elastic nail wandered from distal clavicle in 2 cases, but no nonunion or symptomatic malunion was found, with a complication rate of 3.3% （X^2 = 1. 890, P = 0. 020）; no asymmetry of shoulder was observed; anatomical healing was observed in 56 cases. Conclusion In treatment of displaced mid-clavicle fracture, nonoperative treatment is not recommended because it is obviously inferior to TEN which may be an alternative treatment for displaced midclavicular fracture.

关 键 词：锁骨 骨折 骨钉 治疗结果 

分 类 号：R686[医药卫生—骨科学]