微创经皮锁定重建钢板与弹性髓内钉治疗锁骨中段骨折的对比研究  

Comparison of two minimally invasive internal fixation methods for the treatment of midshaft clavicular fractures

作　　者：冯永增[1] 水小龙[1] 郑亦静[1] 陈龙[1] 汤骏[1] 郭晓山[1] 洪建军[1] 

机构地区：[1]温州医科大学附属第二医院骨科,温州325027

出　　处：《中华手外科杂志》2016年第4期260-263,共4页Chinese Journal of Hand Surgery

摘　　要：目的对应用微创经皮锁定重建钢板与弹性髓内钉治疗锁骨中段骨折的疗效进行对比分析。方法自2010年1月至2014年8月收治62例锁骨中段骨折病例，34例行经皮锁定重建钢板固定（钢板组），28例行经皮弹性髓内钉固定（弹性钉组），对两组病例术中情况，术后第三天疼痛评分、骨折愈合时间、临床疗效及并发症进行对比分析。结果两组在术中C臂机照射时间、术后第三天疼痛评分、A型骨折的愈合时间方面比较，差异均无统计学意义。弹性钉组手术时间短于钢板组，而钢板组B型骨折的愈合时间短于弹性钉组，差异均有统计学意义。术后6个月时，两组的DASH和Constant-Murley评分分别进行比较，A型骨折病例差异均无统计学意义；钢板组B型骨折病例的评分均优于弹性钉组，差异有统计学意义。术后12个月时，两组A型和B型骨折病例的DASH和Constant-Murley评分分别进行比较，差异均无统计学意义。弹性钉组术后更易出现皮肤激惹，而在内固定松动、创口感染、再骨折方面两组差异均无统计学意义。结论经皮锁定重建钢板与弹性髓内钉都是治疗锁骨中段骨折的有效微创内固定方式。但从B型骨折的愈合时间、术后6个月的功能评分及术后并发症来看，经皮锁定重建钢板固定在粉碎性锁骨中段骨折的治疗中更具优势。Objective To evaluate and compare the treatment outcomes of two minimally invasive internal fixation methods for midshaft clavicular fractures. Methods A retrospective study was conducted of 62 patients with midshaft clavicular fractures treated between January 2010 and August 2014. Among them 34 patients were treated with minimally invasive percutaneons locking reconstruction plate fixation （plate group）, while 28 patients were treated with percutaneous elastic intramedullary nail fixation （nail group）. Intraoperative parameters, pain score at postoperative day 3, bone union time, clinical outcomes and complications were compared between the two groups. Results There were no statistically significant differences in intraoperative fluoroscopy time, postoperative pain score and bone union time for type A fractures between the two groups. Surgery time was significantly shorter in the nail group. Bone union time for type B fractures was significantly shorter in the plate group. DASH score or Constant-Murley score for type A fractures were not different between the two groups at 6 months, but significantly higher in the plate group for type B fractures. At 12 months no significant differences in DASH or Constant-Murley scores were noted between the two groups for either type A or type B fractures. A higher rate of skin irritation was seen in the nail group. There were no significant differences between the two groups with regard to infection, loosening or migration of internal fixation and re-fracture. Conclusion Both percutaneous locking reconstruction plate fixation and pereutaneous elastic intramedullary nail fixation are effective minimally invasive methods for treating midshaft clavicular fractures. For type B comminuted midshaft clavicular fractures, percutaneons locking reconstruction plate fixation is a better option due to its shorter bone union time, better function scores and lower complications.

关 键 词：锁骨 骨折固定术 内 锁定重建钢板 弹性髓内钉 

分 类 号：R687.3[医药卫生—骨科学]