经皮克氏针辅助复位微创锁定钢板与切开复位锁定钢板治疗Robinson2B型锁骨中段骨折的疗效比较  

Efficacy comparison between percutaneous Kirschner wire assisted reduction with minimally invasive locking plate and open reduction with locking plate for Robinson type 2B midshaft clavicular fracture

作　　者：章宁杰[1] 吕宇航 王晋钟[1] 何建明[1] 朱海波[1] Zhang Ningjie, Lyu Yuhang, Wang Jinzhong, He Jianming, Zhu Haibo.(Department of Orthopedics, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing 312000, China)

机构地区：[1]绍兴市中医院骨科,浙江省绍兴市312000

出　　处：《中华创伤杂志》2018年第10期925-931,共7页Chinese Journal of Trauma

基　　金：浙江省中医院科技计划科研基金（2017ZB090）

摘　　要：目的 比较经皮克氏针辅助复位微创锁定钢板与切开复位锁定钢板内固定治疗成人Robinson 2B型锁骨中段骨折的临床疗效。 方法 采用回顾性病例对照研究分析2009年6月-2016年10月绍兴市中医院收治的96例Robinson 2B型锁骨中段骨折患者的临床资料，其中男70例，女26例；年龄18—65岁，平均34．5岁。根据手术方式的不同将患者分为两组49例采用经皮克氏针辅助复位微创锁定钢板内固定治疗（微创组）；47例采用切开复位锁定钢板内固定治疗（切开组）。根据Robinson骨折分型：微创组281型28例，282型2l例；切开组281型23例，282型24例。比较两组切口长度、手术时间、术后第2天视觉模拟评分（VAS）、住院时间、骨折愈合时间、术后6个月、1年及末次随访时肩关节Constant评分，以及患者对切口、功能满意度及并发症情况等。 结果微创组和切开组分别获随访（19．6±5．5）个月、（20．3±6．2）个月。微创组和切开组切口长度分别为（4．8±0．7）cm、（8．3±1．6）cm，手术时间分别为（75．5±21．6）min、（60．2±19．1）min，术后第2天VAS分别为（2．9±1．5）分、（3．9±1．7）分，住院时间分别为（7．1-1-2．6）d、（9．5±2．9）d，骨折愈合时间分别为（11．7±2．2）周、（13．4±2．9）周，患者对切口外观满意度分别为84％、60％（P均〈0．01）。两组在术后6个月、1年、末次随访时Constant评分及功能满意度比较差异均无统计学意义（P〉0．05）。微创组和切开组患者术后切口肥厚性瘢痕发生率分别为8％、30％，局部皮肤麻木或感觉减退发生率分别为10％、32％（P均〈0．01）。但两组切口感染、皮下钢板明显突出、内固定失效、骨不连及翻修率比较差异均无统计学意义（P〉0．05）。结论经皮克氏针辅助复位微创锁定钢板内固定与切开复位锁定钢板内固定治疗Robinson 2Objective To compare the outcomes of percutaneous Kirschner wire assisted reduction with minimally invasive plate osteosynthesis and open reduction with locking plate in treatment of Robinson type 2B midshaft clavicular fractures. Methods A retrospective case control study was conducted to analyze the clinical data of 96 patients with Robinson type 2B midshaft clavicular fracture from June 2009 to October 2016. There were 70 males and 26 females with an average age of 34.5 years.The patients were divided into two groups according to the different surgical methods： 49 patients were treated with percutaneous Kirschner wire assisted reduction and minimally invasive locking plate osteosynthesis （minimally invasive group）; 47 patients were treated with open reduction with locking plate internal fixation （open plating group ）. According to the Robinson fracture typing, there were 28 patients with type 2B1 and 21 with type 2B2 in the minimally invasive group; there were 23 patients with type 2B1 and 24 with type 2B2 in open plating group. The length of incision, operation time, visual analog scale （VAS） 2 days after surgery, length of hospital stay, time of fracture healing, Constant score results of postoperative 6 months, 1 year, and at the last follow-up, feedbacks on incision and functional satisfaction, and complications were compared between the two groups. Results The average follow- up was 19.6 ± 5.5 ） months in minimally invasive group and （20.3 ± 6.2） months in open plating group. The incision lengths of the minimally invasive group and the open plating group were （4.8 ± 0.7） cm and （8.3 ± 1.6 ） cm, respectively. The minimally invasive group had significantly longer operation time [ （75.5 ±21.6） minutes] compared with open plating group [ （60.2 ± 19.1 ）minutesl （P 〈0.01 ）. In the minimally invasive group and open plating group, the VAS 2 days after surgery was （ 2.9 ± 1.5 ） points and （3.9 ± 1.7 ） points ; the hospitalization time was （ 7. 1 ± 2.6 �

关 键 词：锁骨 骨折固定术 内 微创钢板接骨术 

分 类 号：R687.3[医药卫生—骨科学]