锁骨中段骨折分型及可塑性夹板治疗的临床观察  

Clinical observation on plastic splint treatment of middle clavicle fracture based on a new classification

作　　者：朱兴涛 孙轶韬 孙一夫 林顺 姜宏[2] 刘锦涛[2] ZHU Xing-tao;SUN Yi-tao;SUN Yi-fu;LIN Shun;JIANG Hong;and LIU Jin-tao(不详;Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine,Suzhou 215007,Jiangsu,China)

机构地区：[1]南京中医药大学,江苏南京210023 [2]南京中医药大学附属苏州市中医医院,江苏苏州215007

出　　处：《中国骨伤》2022年第3期258-264,共7页China Journal of Orthopaedics and Traumatology

基　　金：第3批江苏省老中医药专家学术经验继承项目[编号:苏科教(2019)8号]。

摘　　要：目的:根据73例保守治疗的锁骨中段骨折病例,提出一种锁骨中段骨折分型并观察可塑性夹板治疗该分型锁骨中段骨折患者的临床疗效。方法:回顾性分析2018年9月至2020年8月采用可塑性夹板治疗的73例锁骨中段骨折患者,根据骨折移位类型将73例患者分为4型。Ⅰ型16例,男7例,女9例;年龄18~37(28.6±7.8)岁;病情轻度12例,中度3例,重度1例。Ⅱ型16例,男6例,女10例;年龄25~49(37.3±9.4)岁;病情轻度5例,中度8例,重度3例。Ⅲ型7例,男4例,女3例;年龄33~57岁;病情轻度2例,中度3例,重度2例。Ⅳ型34例,男16例,女18例;年龄48~82(66.4±14.9)岁;病情轻度7例,中度17例,重度10例。所有患者接受可塑性夹板外固定治疗4周。观察记录治疗前及治疗1、3、9个月后的疼痛视觉模拟评分(visual analgue scale,VAS)评分及Constant-Murley肩关节评分以评估患者患肢治疗前后的疼痛程度变化情况和肩关节功能恢复情况。末次随访时记录患者对治疗后外观是否满意,根据末次随访时X线表现判断患者是否发生骨折不愈合,并根据骨折愈合时间及影像学表现综合得出不同分型患者临床疗效的优良率。结果:所有患者获得随访,时间9~11(9.8±0.7)个月。Ⅰ、Ⅱ、Ⅳ型治疗前VAS分别为(2.88±0.83)、(3.67±0.80)、(6.92±1.71)分,治疗9个月后分别降至(0.54±0.19)、(0.77±0.25)、(1.18±0.17)分。Ⅰ、Ⅱ、Ⅳ型Constant-Murley肩关节评分治疗前分别为(65.81±2.09)、(63.50±2.22)、(47.93±2.91)分,治疗9个月后分别升至(88.56±2.11)、(85.12±2.23)、(71.25±2.16)分。5例对治疗后的外观不满意;6例在治疗9个月后未见明显连续性骨痂通过,为骨折不愈合。结论:锁骨中段骨折分型与临床更为贴切,对锁骨中段骨折治疗方式的选择及预后有一定的临床指导意义。可塑性夹板治疗无明显移位及重叠移位的锁骨中段骨折近期临床疗效确切且并发症发生率较低,可以在临床中推广使用�Objective:According to 73 patients with middle clavicle fracture treated conservatively,a new classification of middle clavicle fracture was proposed,and the clinical effect of plastic splint in the treatment of middle clavicle fracture was observed.Methods:Total 73 patients with middle clavicle fracture treated with plastic splint from September 2018 to August 2020 were analyzed retrospectively.All the patients were divided into 4 types according to the degree of fracture displacement.There were 16 cases of typeⅠ,including 7 males and 9 females,ranging in age from 18 to 37 years old,with a mean of(28.6±7.8)years old;12 cases of mild disease,3 cases of moderate disease and 1 case of severe disease.There were 16 cases of typeⅡ,including 6 males and 10 females,ranging in age from 25 to 49 years old,with a mean of(37.3±9.4)years old;5 cases of mild disease,8 cases of moderate disease and 3 cases of severe disease.There were 7 cases of typeⅢ,including 4 males and 3 females,ranging in age from 33 to 57 years old;2 cases of mild disease,3 cases of moderate disease and 2 cases of severe disease.There were 34 cases of typeⅣ,including 16 males and 18 females,ranging in age from 48 to 82 years old,with a mean of(66.4±14.9)years old;7 cases of mild disease,17 cases of moderate disease and 10 cases of severe disease.All patients received plastic splint external fixation for 4 weeks.Visual analgue scale(VAS)and Constant-Murley shoulder scores before treatment and 1,3 and 9 months after treatment were observed and recorded to evaluate the change of pain degree and shoulder function recovery before and after treatment.The patients'satisfaction with the appearance after treatment was recorded at the latest follow-up.The X-ray findings at the latest follow-up were used to judge whether the patient had fracture nonunion.And according to the fracture healing time and imaging findings,the excellent and good rate of clinical curative effect in patients with different types was obtained.Results:All patients were followed up

关 键 词：锁骨 骨折 小夹板固定术 

分 类 号：R684[医药卫生—骨科学]