锁定钢板经皮微创内固定治疗锁骨中段骨折  

Mini-invasive percutaneous plating of midshaft clavicle fractures with locking plate

作　　者：董文伟[1] 毛海蛟[1] 史增元[1] 姚立炜 吴泽庭 Dong Wenwei;Mao Haijiao;Shi Zengyuan;Yao Liwei;Wu Zeting(Department of Traumatic Orthopaedics,The Affiliated Hospital of Medical School of Ningbo University,Ningbo 315000,China)

机构地区：[1]宁波大学医学院附属医院创伤骨科,315000

出　　处：《中华骨科杂志》2020年第23期1601-1611,共11页Chinese Journal of Orthopaedics

基　　金：浙江省基础公益研究计划项目(LGF20H060008)。

摘　　要：目的介绍一种利用锁骨外侧锁定钢板间接复位、微创内固定治疗锁骨中段骨折的手术方法,并通过与切开复位重建锁定钢板固定方法对比,评价其临床应用疗效。方法回顾分析2017年8月至2019年3月应用锁骨外侧解剖锁定型钢板间接复位微创固定治疗的锁骨中段骨折患者30例(微创治疗组),男22例、女8例;年龄(44.63±13.22)岁(范围14~65岁);根据Robinson分型:2A2型9例、2B1型17例、2B2型4例;术前均无发现血管、神经损伤;受伤至手术时间(2.33±1.75)d(范围0~7 d)。选取同一术者以往采用切开复位重建锁定钢板固定治疗的锁骨中段骨折患者32例(切开治疗组);男25例,女7例,年龄(42.63±14.18)岁(范围16~70岁),根据Robinson分型:2A2型6例、2B1型19例、2B2型7例,进行对照研究。研究项目包括切口长度、手术时间、术中出血量、透视次数、骨折复位情况、骨痂形成时间、肩关节Constant-Murley评分及相关并发症。结果微创治疗组30例患者均完成了间接复位微创内固定治疗,手术时间(63.40±7.82)min(范围48~92 min),术中透视(4.83±1.58)次(范围3~8次),术中出血(15.67±4.13)ml(范围10~30 ml);切开治疗组手术时间(56.22±10.11)min(范围42~80 min),术中透视(3.91±1.49)次(范围2~5次),术中出血(56.88±13.93)ml(范围40~100 ml);两组在手术时间、透视次数及出血量方面均有差异(P<0.05)。微创治疗组术前患侧与健侧相比锁骨长度短缩12.15%±2.69%(范围5.2%~15.1%),术后锁骨长度短缩0.45%±0.44%(范围-0.2%~1.6%),与切开治疗组术前锁骨长度短缩11.58%±2.67%(范围4.5%~16.1%),术后锁骨长度短缩0.62%±0.41%(范围-0.2%~1.2%)相比,差异无统计学意义(P>0.05)。微创治疗组随访(11.3±2.8)个月(范围10~18个月),骨痂形成时间(3.57±0.90)个月(范围3~5个月);切开组随访(11.8±2.2)个月(范围10~18个月),骨痂形成时间(4.27±1.12)个月(范围3~6个月)。术后6个月微创治疗组患者切口总长度(2.8±0.48)cmObjective To introduce a new operative technique of mini-invasive plating of midshaft clavicle fractures with lateral clavicle anatomic locking plate and evaluate its clinical outcomes.Methods From August 2017 to March 2019, 30 midshaft clavicular fracture patients were included in this study and retrospectively analyzed. There were 22 males and eight females with an average of 44.63±13.22 years (range 14-65 years). According to Robinson classification nine patients were classified as Type 2A2, 17 patients were classified as Type 2B1 and four patients were classified as Type 2B2. Before operation no symptoms of neurovascular injury was observed in this group. Operations were performed on an average of 2.33±1.75 d (range 0-7 d) after the injury. By comparing the injured clavicle lengths with the opposite healthy side pre and postoperatively on anteroposterior chest x-ray to evaluate the effect of indirect reduction. Shoulder function was evaluated using the Constant-Murley score at 6th month after the operation. Meanwhile, 32 patients with midshaft clavicular fracture treated with open reduction and internal fixation using clavicle reconstruction locking plate treated by the same group surgerons were compared in incision length, surgical duration, intraoperative fluoroscopy times, blood loss, fracture reduction, fracture healing time, Constant-Murley score and other complications. There were 25 males and seven females with an average of 42.63±14.18 years (range 16-70 years). According to Robinson classification six patients were classified as Type 2A2, 19 patients were classified as Type 2B1 and seven patients were classified as Type 2B2.Results In mini-invasive group all patients were treated successfully with minimally invasive percutaneous osteosynthesis (MIPO) technique using lateral clavicle anatomic locking plate. The mean surgical duration was 63.40±7.82 minutes (range 48-92 min), The mean intraoperative fluoroscopy was 4.83±1.58 times (range 3-8 times). The mean blood lose was 15.67±4.13ml (range 10-

关 键 词：外科手术 微创性 锁骨 骨折 对比研究 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]