锁骨骨折术后内固定失败的手术治疗  

Surgical treatment of internal fixation failure after clavicular fracture operation

作　　者：芦浩[1] 姜保国[1] 付中国[1] 张殿英[1] 王天兵[1] 徐海林[1] 张培训[1] 

机构地区：[1]北京大学人民医院创伤骨科,北京大学交通医学中心,北京100044

出　　处：《北京大学学报（医学版）》2014年第5期766-770,共5页Journal of Peking University:Health Sciences

基　　金：卫生部卫生公益性行业科研专项基金(201002014);教育部新世纪优秀人才支持计划(BMU20110270)~~

摘　　要：目的：探讨锁骨骨折术后内固定失败的手术治疗效果。方法：纳入2005年1月至2013年1月手术治疗的15例锁骨骨折术后内固定失败的患者,依据骨折分型、内固定失效时间以及内固定类型采用不同的治疗方法,对患者术后骨折愈合情况、肩关节功能、肩关节疼痛进行评价。结果：随访时间5~101个月,平均43.8个月,所有患者的骨折均愈合。患侧肩关节Constant评分为82~100分,平均93.3分;健侧肩关节Constant评分为85~100分,平均96.7分,双侧相比差异有统计学意义（P=0.02）。随访时有8例患者的患侧肩关节没有疼痛,而另外7例存在不同程度的轻度疼痛,视觉模拟评分法（visual analogue scale,VAS）评分为1~3分,患侧和健侧VAS评分的差异有统计学意义（P=0.03）。结论：锁骨骨折术后早期内固定失败的原因是内固定稳定性不佳,可通过更换内固定治疗,而晚期失败是由骨折不愈合所引起,萎缩性骨不连应使用锁定钢板进行桥接固定并使用自体髂骨植骨,手术治疗可取得满意的疗效。Objective： To investigate the surgical treatment results of implant failure after clavicular fracture open reduction and internal fixation（ ORIF）. Methods： Fifteen cases from Jan. 2005 to Jan.2013 were treated surgically according to fracture classification,time of implant failure and implant type.The fracture union,shoulder function and pain were evaluated postoperatively. Results： All the patients had full follow-up for 5 to 101 months（ mean： 43. 8 months）. All the fractures were united well. The constant scores to assess the shoulder function were 82 to 100（ mean： 93. 3 in the fracture side） and were 85 to 100（ mean： 96. 7 in the uninjured side）; statistically significant difference of the constant scores between the two sides was found（P = 0. 02）. Eight cases did not have shoulder pain in the fracture side,while the other 7 cases had mild pain,The visual analogue scale（ VAS） scores to evaluate shoulder pain were 1 to 3 in the fracture side,which were statistically different from those in the uninjured side（P = 0. 03）. Conclusion： Implant instability causes early implant failure after clavicular fracture ORIF and re-fixation with stable implant is effective. Fracture nonunion leads to late implant failure,and bridging fixation using locking plate associated with bony autograft with iliac crest is a successful method to treat atrophy clavicular nonunion. Surgical treatment can bring good results.

关 键 词：锁骨 骨折固定术 内 治疗结果 

分 类 号：R683.41[医药卫生—骨科学]