弹性髓内钉与钢板治疗锁骨骨折前瞻性研究  

Prospective Study on Treatment of Clavicle Fracture with Elastic Intramedullary Nail and Plate

作　　者：杜浩[1] 田笑笑[1] 郭丹 涂世成 王坤[1] Du Hao;Tian Xiaoxiao;Guo Dan(The First Affiliated Hospital,and College of Clinical Medicine of Henan University of Science and Technology,Henan 471003,China)

机构地区：[1]河南科技大学临床医学院、河南科技大学第一附属医院,洛阳471003

出　　处：《医学研究杂志》2020年第4期145-148,152,共5页Journal of Medical Research

摘　　要：目的前瞻性对比研究小切口切开复位弹性髓内钉内固定与常规切开复位长跨度重建钢板内固定治疗锁骨中段粉碎性骨折的临床疗效、预后及并发症。方法收集2015年3月~2017年12月期间笔者医院收治的72例锁骨中段粉碎性骨折患者,分别采用弹性髓内钉或重建钢板桥接固定。采取计算机单盲随机分组法随机分为两组,每组36例,A组采取髓内钉,B组采取钢板,对比评估两组的切口长度、手术时间、术中出血量、住院时间;出院后定期随访及摄片,评估两组的骨折愈合时间、术后并发症,并按Constant-Murley(CM)评分评价患侧肩关节功能。结果A组患者的切口长度、手术时间、术中出血量、住院时间少于B组(P<0.05),两组并发症发生率比较,差异无统计学意义(P>0.05),A组主要为退钉、钉尾滑囊炎等;B组主要为切口局部感觉减退;A组的骨折愈合时间比B组短(P<0.05);两组术后12个月患侧肩关节CM评分比较,差异无统计学意义(P>0.05)。结论小切口弹性髓内钉与长跨度重建钢板治疗锁骨粉碎性骨折各有优缺点,需要合理选择内固定物,避免出现并发症。Objective Prospective comparative study on clinical efficacy,prognosis and complications of elastic intramedullary nail by small incision and long-span reconstructive plate by conventional open reduction in the treatment of comminuted fracture of middle clavicle.Methods Seventy-two patients with comminuted fracture of middle clavicle received operation by elastic intramedullary nail or long-span reconstructive plate from March 2015 to December 2017.Using computer single blind random grouping method,they were randomly divided into two groups with 36 cases in each group.Intramedullary nails were used in group A and plates in group B.The incision length,operation time,intraoperative blood loss and hospitalization time of the two groups were compared and evaluated.After discharge,regular follow-up and radiography were performed to evaluate the fracture healing time and postoperative complications of the two groups,and the affected shoulder joint function was evaluated according to Constant-Murley(CM)score.Results Group A was better than group B in incision length,operation time,intraoperative blood loss and hospitalization time(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Group A was mainly characterized by bursitis of nail tail and nail withdrawal,and 1 case had delayed union of fracture.Group B was mainly characterized by local hypoesthesia and superficial wound infection,and 2 case had delayed union of fracture.Fracture healing time in group A was shorter than that in group B(P<0.05).At 12 months after operation,there was no significant difference in CM score of affected shoulder joint(P>0.05).Conclusion Each has its advantages and disadvantages in the treatment of comminuted fracture of middle clavicle between elastic intramedullary nail by small incision and long-span reconstructive plate by conventional open reduction.Clinicians should choose a fixed way according to the degree of fracture comminution and the surgical skill before operation,give fu

关 键 词：锁骨 骨折固定术 粉碎性 重建钢板 弹性髓内钉 

分 类 号：R683.41[医药卫生—骨科学]