微创经皮钢板内固定治疗锁骨中段骨折  

Minimally invasive treatment of mid-shaft clavicle fracture with anatomical locking compression plate

作　　者：蒋华军[1] 赵巍[1] 刘斯达 张卫国[1] 曲巍[1] Jiang Huajun;Zhao Wei;Liu Sida;Zhang Weiguo;Qv Wei(Department of Hand Microsurgery,the First Affiliated Hospital of Dalian Medical Univers ity,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一医院手显微外科,116000

出　　处：《中华肩肘外科电子杂志》2018年第4期266-272,共7页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：国家自然科学基金面上项目(30973060)

摘　　要：目的比较常规切开复位内固定和微创经皮钢板内固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗锁骨中段骨折的临床疗效。方法回顾性分析2012年1月至2014年12月大连医科大学附属第一医院收治的锁骨中段骨折患者共86例,根据手术方法分为切开复位内固定组(A组,41例)和MIPPO(B组,45例)。对比两组患者的手术情况、术后一般情况、肩关节功能Constant-Murley评分、术后并发症发生率。结果两组患者在手术时间、住院时间和骨折愈合时间方面差异均无统计学意义;最终Constant-Murley评分总分及日常生活、疼痛、活动度差异均无统计学意义;但术后并发症(术区麻木及肥大瘢痕)B组发生率显著低于A组。结论与切开复位钢板内固定相比,MIPPO治疗锁骨中段骨折创伤较少,术后并发症(术区麻木及肥大瘢痕)发生率低,值得临床应用。Background Accounting for 6%of all fractures,clavicle fractures are common in clinic with the middle 1/3 fracture as the most common type.The options for treatment include conservative and surgical strategies.The effect of conservative treatment via manipulative reduction is often unsatisfactory(especially for comminuted fractures).For the middle 1/3 clavicle fractures,the displacement of proximal end caused by the upward and posterior tractions of sternocleidomastoid muscle may result in instability and nonunion of fracture.These risk factors increase the chance of redisplacement,which restrict early activity and affect joint function simultaneously.With in-depth study of the injury and therapeutic effect of clavicle fractures and patients'improved expectation for life quality,more patients require surgical treatment.Those with comminuted and shortened fractures are often treated with plate fixation.The surgical treatment reduces complications including nonunion,shoulder deformity,pain,functional impairment and neurovascular injury,et al.,and greatly improves the clinical therapeutic effect of clavicular fracture.However,the excessive dissection of surrounding tissue required by conventional plate fixation increases the chance of nonunion.Moreover,the large incision on skin not only leads to the formation of large scar but also causes supraclavicular nerve damage and numbness in the corresponding area.The minimally invasive percutaneous plate osteosynthesis(MIPPO)technique can nicely solve some of the common drawbacks of traditional surgery.MethordⅠ.General information:From January 2012 to December 2014,86 patients(52 males and 34 females)with mid-shaft clavicle fractures were treated in the first affiliated hospital of dalian medical university.The age ranged from 14 to 70 years old with an average of 40 years.All cases were closed fractures,which included 48 cases of traffic accident and 38 cases of fall injury.36 cases were affected by left side,and 50 cases were affect by right side.Among the patients,ther

关 键 词：锁骨中段骨折 微创 复位 内固定 

分 类 号：R687.3[医药卫生—骨科学]