小切口重建钢板治疗锁骨中段骨折的比较研究  

Treatment of Midshaft Clavicle Fractures with Reconstructive Plate through Minimal Incision:A Comparison Study

作　　者：蔡俊丰[1] 祝建光[1] 彭庄[1] 尹峰[1] 刘林[1] 袁峰[1] 

机构地区：[1]同济大学附属东方医院骨科,上海200120

出　　处：《中国微创外科杂志》2010年第9期792-794,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的比较小切口与传统切口重建钢板治疗锁骨中段骨折的临床效果。方法 2007年3月～2009年5月,采用小切口(0.5～3.5cm)重建钢板治疗15例锁骨中段骨折,与前期2005年8月～2007年3月采用传统切口重建钢板治疗的20例进行比较。手术由同一术者完成,记录每个病例的手术切口长度、手术时间、出血量、术后24h疼痛评分、骨折愈合时间、术后3个月功能、并发症及病人对切口的满意率,并进行统计分析。结果所有病例均获随访6～18个月,平均13个月。小切口手术在切口长度[(3.5±0.5)cmvs(7.3±1.1)cm,t=-12.540,P=0.000],出血量[(55.0±10.2)mlvs(95.0±15.7)ml,t=-8.578,P=0.000],术后24h疼痛评分[(29.0±9.3)分vs(46.0±9.4)分,t=-5.318,P=0.000],骨折愈合时间[(9.1±1.1)周vs(10.8±1.3)周,t=-4.007,P=0.000]及病人对切口的满意率[80%(12/15)vs25%(5/20),χ2=10.380,P=0.001]方面均明显优于传统切口手术,而手术时间、并发症和术后3个月肩关节功能差异无显著性(P>0.05)。结论小切口重建钢板治疗锁骨骨折能减小创伤、减少出血、加快骨折愈合,且外形美观,是一种治疗锁骨中段骨折较好的方法,但此种术式对医师的技术要求较高。Objective To compare the efficacy of minimal incision with traditional incision in the treatment of midshaft clavicle fractures.Methods From March 2007 to May 2009,totally 15 patients with midshaft clavicle were treated with reconstructive plate though a minimal incision in our hospital.Twenty patients who received the surgery via a traditional incision between August 2005 and March 2007 were set as a control group.All the operations were done by a same group of surgeons.The incision length,operation time,blood loss,24-hour VAS score,bone union time,function recovery 3 months after the surgery,complications,and patients＇ satisfaction on the incision were statistically analyzed.ResultsThe patients were followed up for 6-18 months with a mean of 13 months.The minimal incision group had significantly shorter incision length,less operation time and blood loss,lower 24-hour VAS score,shorter mean time of bone union,and higher satisfaction rate on the incision [（3.5±0.5）cm vs（7.3±1.1）cm,t=-12.540,P=0.000;（55.0±10.2）ml vs（95.0±15.7）ml,t=-8.578,P=0.000;（29.0±9.3）vs（46.0±9.4）,t=-5.318,P=0.000;（9.1±1.1）weeks vs（10.8±1.3）weeks,t=-4.007,P=0.000;80%（12/15）vs 25%（5/20）,χ^2=10.380,P=0.001] than the traditional incision group.Whereas,no significant difference was detected between the two groups on operation time,complication rates,and the recovery of shoulder joint function（P〈0.05）.Conclusions Minimal incision is a good choice for the treatment of midshaft clavicle fractures with reconstructive plate.The procedure causes less trauma and blood loss,quick recovery,and satisfying cosmetic results.However,the technique is more complicated than traditional method and thus specially trained surgeons are requested.

关 键 词：锁骨中段骨折 小切口 重建钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]