桥接组合式内固定系统对老年锁骨中段移位骨折愈合和肩关节功能的影响  

Effects of bridge combined internal fixation system internal fixation on fracture healing and shoulder joint function in older patients with displaced midshaft clavicle fractures

作　　者：王广欣[1] 肖万军[1] 王臣[1] 梁庆威[2] WANG Guang-xin;XIAO Wan-jun;WANG Chen;LIANG Qing-wei(Department of Orthopedics,the 4th People's Hospital of Shenyang,Shenyang 110031,Liaoning Province,China;Department of Orthopedics,the First Hospital of China Medical University,Shenyang 110000,Liaoning Province,China)

机构地区：[1]沈阳市第四人民医院骨科,辽宁沈阳110031 [2]中国医科大学第一附属医院骨科,辽宁沈阳110000

出　　处：《海南医学院学报》2019年第18期1396-1400,共5页Journal of Hainan Medical University

基　　金：国家卫生计生委医药卫生科技发展研究中心基金项目(W2015QJ138)~~

摘　　要：目的:对比桥接组合式内固定系统和锁定钢板系统在促进老年患者锁骨中段移位骨折愈合、改善肩关节功能方面的作用。方法:纳入2016年2月~2018年2月沈阳市第四人民医院骨科收治的Robinson 2B型移位锁骨中段骨折老年患者44例,根据内固定方法将患者分为桥接组合式内固定系统组(桥接组)和锁定加压钢板内固定组(钢板组),每组22例。记录患者的手术时间、术中出血量、骨折愈合时间、术后并发症情况。术后12个月时采用肩关节Constant-Murley评分和DASH评分评估患者关节活动功能恢复情况。于术前及术后3个月测定患者血清骨转换生化标志物I型前胶原氨基端肽(P1NP)、I型胶原交联羧基末端肽(CTX-I)、骨膜蛋白(OSF)的水平。结果:桥接组手术时间、术中出血量、骨折愈合时间均明显较钢板组短(P<0.05)。桥接组术后12个月Constant评分和DASH评分均明显优于钢板组短(P<0.05)。桥接组术后3个月血清I型胶原交联羧基末端肽明显下降,I型前胶原氨基端肽和骨膜蛋白水平均较术前明显升高(P<0.05),且桥接组较钢板组变化更为明显(P<0.05)。桥接组手术并发症发生率虽低于钢板组,但差异无统计学意义(P>0.05)。结论:桥接组合式内固定系统较锁定钢板系统能够有效提高手术效率,更利于骨折愈合,更好的促进患者功能恢复,减少内固定失败率,从而为手术内固定治疗老年锁骨中段移位骨折提供了一种较好的内固定物选择。Objective:To compare the clinical therapeutic effect of bridge combined internal fixation system and locking compression plate internal fixation in the treatment of displaced midshaft clavicle fractures by emphatically observing fracture healing and shoulder joint function.Methods:Forty-four elderly patients with Robinson type 2B displaced midshaft clavicle fractures were included from the Department of Orthopaedics,Shenyang Fourth People's Hospital during February 2016 and December 2018,including 23 males and 21 females,mean age(69.8±10.2)years old.The patients were divided into a bridge combined internal fixation system group(bridge group,n=22)and a locking compression plate internal fixation group(plate group,n=22)according to the internal fixation methods.The operation time,intraoperative blood loss,fracture healing time,and postoperative complications were recorded.At 12 months after surgery,the shoulder joint Constant-Murley score and DASH score were used to assess the recovery of joint function.The serum levels of bone turnover biochemical markers procollagen I N-terminal peptide(P1NP),cross-linked Carboxy-terminal telopeptide of typeⅠcollagen(CTX-I),and osteoblast specific factor(OSF)were measured before and 3 months after surgery.Results:The operation time,intraoperative blood loss and fracture healing time of the bridge group were significantly shorter than those of the plate group(P<0.05).Constant scores and DASH scores in the bridge group were significantly better than those of the plate group at 12 months after surgery(P<0.05).Serum levels of CTX-I was significantly decreased,while the P1NP and OSF were significantly increased compared with before surgery in the both groups(P<0.05),and the changes were more obvious in the bridge group(P<0.05).The incidence of complications was similar between the two groups(P<0.05).Conclusion:Compared with the locking plate system,the bridge combined internal fixation system can effectively improve the operation efficiency,have more benefits on fracture healing,be

关 键 词：桥接组合式内固定 锁定钢板 老年 锁骨中段移位骨折 骨折愈合 

分 类 号：R687.3[医药卫生—骨科学]