弹性髓针与锁定钢板治疗锁骨中段骨折的疗效对比  

Efficacy of elastic intramedullary nail versus locking plate fixation in the treatment of middle clavicle fracture

作　　者：彭琳博 陈晓斌 张建政 王晓伟 孙天胜 Peng Lin-bo;Chen Xiao-bin;Zhang Jian-zheng;Wang Xiao-wei;Sun Tian-sheng(Department of Orthopedics,Army General Hospital,Second Medical College,Southern Medical University,Beijing 100010,China)

机构地区：[1]南方医科大学第二临床医学院陆军总医院骨科,北京市100010

出　　处：《中国组织工程研究》2018年第11期1671-1676,共6页Chinese Journal of Tissue Engineering Research

基　　金：军委后勤保障部卫生局应用基础研究项目(16CXZ002);课题名称:四肢骨关节及脊柱脊髓战创伤专科救治研究~~

摘　　要：背景:对于锁骨中段骨折的治疗,弹性髓针因为其切口小、手术时间短等优势在临床上逐步得到大家的认可。而切开复位锁定钢板内固定术是目前主要的手术治疗方式。目前,已有少量对于两种方式治疗结果的对比研究,但结果仍有争议,尤其缺乏长期疗效和并发症的对比研究。目的:对于锁定钢板和弹性髓针治疗锁骨中段骨折的临床结果及并发症进行对比。方法:回顾分析2014年6月至2015年6月在南方医科大学第二临床医学院陆军总医院住院并接受手术治疗的锁骨中段骨折患者85例,根据内固定物不同分为2组,锁定钢板组62例,弹性髓针组23例。对比2组患者术中切口长度、手术时间、出血量及住院时间;出院后定期随访及摄片评估骨折愈合情况、术后并发症以及肩关节功能。结果与结论:(1)弹性髓针组患者在切口长度、手术时间、出血量、住院时间方面均优于锁定钢板组(P<0.05);(2)弹性髓针组术后并发症远低于锁定钢板组,差异有显著性意义(P<0.05)。锁定钢板组并发症主要为伤口浅表感染、切口局部感觉减退和内植物突起症状;弹性髓针组仅有2例患者出现退钉并发症;(3)弹性髓针组术后骨折愈合率高于锁定钢板组,但差异无显著性意义(P>0.05);(4)2组患者术后12个月上肢功能评定标准评分和Constant-Murley评分差异无显著性意义(P>0.05);(5)提示锁骨弹性髓针与锁定钢板均为治疗锁骨中段骨折确切有效的方法。弹性髓针在切口长度、手术时间、出血量及平均住院时间方面有明显优势,并发症发生率低,术后恢复快;但其同时存在一定的弹性髓针退钉可能,刺激局部皮肤,对患者生活造成一定影响。BACKGROUND:For the treatment of middle clavicle fractures,elastic intramedullary nailing has gradually gained everyone's approval because of its small incision and short operation time.Locking plate fixation is currently the main surgical treatment.At present,there are a few comparative studies on the results of the two surgical treatments,but the results are still controversial.In particular,there is a lack of comparative studies on long-term efficacy and complications.OBJECTIVE:To compare clinical results and complications of locking plate and elastic intramedullary nailing for middle clavicular fracture.METHODS:A retrospective analysis of 85 patients with middle clavicular fractures who were hospitalized at the Army General Hospital of Second Medical College of Southern Medical University from June 2014 to June 2015 undergoing surgeries was performed.They were divided into two groups randomly:locking plate group(n=62)and elastic intramedullary nailing group(n=23).The incision length,operation time,blood loss and time of hospital staying were compared between the two groups.Regular follow-up,radiography assessment and postoperative complications and shoulder function score were measured.RESULTS AND CONCLUSION:(1)Incision length,operation time,blood loss and time of hospital staying were significantly better in the elastic intramedullary nailing group than in the locking plate group(P<0.05).(2)The complications of the elastic intramedullary nailing group were significantly lower than that of the locking plate group(P<0.05).The main complications of locking plate group were superficial wound infection,hypesthesia in the local incision and implant protuberance.Only two patients in the intramedullary nailing group experienced complications.(3)The healing rate of elastic intramedullary nailing group was higher than that of the locking plate group,which was not statistically significant(P>0.05).(4)The DASH scores and the Constant-Murley scores of the two groups after operation were not statistically significant(P>0.0

关 键 词：锁骨中段骨折 弹性髓针 锁定钢板内固定 并发症 锁骨 骨折 内固定器 组织工程 

分 类 号：R318[医药卫生—生物医学工程]