多轴锁定接骨板、重建接骨板、重建带治疗锁骨中段骨折  

Operative treatment of clavicle midshaft fractures: comparison among polyaxial locking plate,reconstruction plate and universal reconstruction ribbon plate

作　　者：刘凤祥[1] 龚伟华[1] 唐坚[1] 孙月华[1] 朱振安[1] 

机构地区：[1]上海市骨科内植物重点实验室 上海交通大学医学院附属第九人民医院骨科,上海200011

出　　处：《中国骨与关节外科》2013年第6期505-509,514,共6页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金资助项目(81171729);上海教委重点学科建设基金(J50206)

摘　　要：背景：切开复位接骨板内固定是移位性锁骨中段骨折的常用治疗方法。目前，临床上有多种植入物可供选择。然而，不同的植入物各有其特点，对于哪种植入物更为理想尚无定论。 目的：比较解剖型多轴锁定接骨板、重建接骨板与通用重建带接骨板治疗锁骨中段骨折的疗效。 方法：2009年11月至2012年2月，切开复位内固定治疗锁骨中段骨折91例，男61例，女30例；年龄18~70岁，平均43.5岁。其中解剖型多轴锁定接骨板内固定30例（锁定组）、重建接骨板内固定30例（重建接骨板组）、通用重建带接骨板内固定31例（重建带组）。记录三组手术时间、骨折愈合时间、术后并发症；采用Constant评分评定肩关节功能。 结果：三组患者年龄、性别、优势侧别、损伤机制、骨折类型、受伤至手术时间、随访时间等方面无显著统计学差异（P〉0.05）。所有患者均获得良好骨折复位及内固定。无感染、医源性神经血管及胸膜损伤。锁定组手术时间、软组织激惹发生率低于重建接骨板组及重建带组（〈0.01，〈0.05），肩关节功能优于重建接骨板及重建带组（〈0.05，〈0.01）；三组患者骨折愈合时间及肥厚性瘢痕形成率无显著差异（P〉0.05）。 结论：解剖型多轴锁定接骨板、重建接骨板、通用重建带接骨板均可用于治疗锁骨中段骨折；应用多轴锁定接骨板手术时间更短，临床效果优良，并发症更少。Background：Open reduction and internal fixation is commonly used for the treatment of displaced midshaft clavicle frac-tures. To date, various implants have been developed for open reduction of these fractures. However, different implants have different characteristics. The optimal implant for midshaft fractures of the clavicle remains undetermined. 〈br〉 Objective：To compare the clinical outcomes of anatomical polyaxial locking plate, reconstruction plate and universal recon-struction ribbon plate for the treatment of clavicle midshaft fractures. 〈br〉 Methods：From November 2009 to February 2012, 91 cases of mid-clavicle fractures were treated with open reduction and internal fixation by using anatomical polyaxial locking plates （30 cases）, reconstruction plates （30 cases）, and universal re-construction ribbon plates （31 cases）, respectively. The operation time, bone healing time and postoperative complications were recorded. The shoulder functions were evaluated according to the Constant＆#39;s scoring system. 〈br〉 Results：There was no significant difference between groups with respect to age, gender, dominant arm, mechanism of inju-ry, type of fractures, the interval from injury to operation, and the follow-up period （P＆gt;0.05）. Postoperative X-ray photogra-phy confirmed satisfactory fracture reduction and internal fixation in all the cases. Infection and iatrogenic neurologicalascu-lar or pleura injuries were not observed in all patients. The operation time and the incidence of soft tissue irritation patients with anatomical polyaxial locking plates were significantly lower than those with reconstruction plates and universal recon-struction ribbon plates （P＆lt;0.01, P＆lt;0.05）. The shoulder function of patients with locking plates were superior to those with reconstruction plates or universal reconstruction ribbon plates （P＆lt;0.05, P＆lt;0.01）. There was no significant difference in terms of fracture healing time and hypertrophic scar incidence （P＆gt;0

关 键 词：锁骨骨折 中段 骨折固定术 内 多轴锁定接骨板 重建接骨板 通用重建带接骨板 

分 类 号：R687.3[医药卫生—骨科学]