3种内固定方式治疗锁骨近端骨折的疗效比较  

Effect comparison of three kinds of internal fixation methods for treatment of proximal clavicular fracture

作　　者：李亮 杨三华 杨展 马成志 吴洪晓 韩晓川 LI Liang;YANG San-hua;YANG Zhan;MA Cheng-zhi;WU Hong-xiao;HAN Xiao-chuan(Dept of Emergency Surgery,the People′s Hospital of Dongying City,Dongying,Shandong 257091,China)

机构地区：[1]东营市人民医院急诊外科,山东东营257091 [2]利津县中医院药剂科,山东东营257447

出　　处：《临床骨科杂志》2022年第5期679-683,共5页Journal of Clinical Orthopaedics

摘　　要：目的 比较3种内固定方式治疗锁骨近端骨折的疗效。方法 将34例锁骨近端骨折患者按照内固定方式不同分为反置组(采用反置锁骨远端解剖型锁定钢板固定,9例)、微型组(采用双微型钢板固定,12例)、环抱器组(采用记忆合金环抱器固定,13例)。记录3组术后并发症发生情况、骨折愈合情况(术后开始工作时间、骨折愈合时间),采用肩关节Constant-Murley评分、疼痛VAS评分、臂肩手功能障碍评分、肩关节活动度等指标评价临床疗效。结果 患者均获得随访,时间12~18个月。微型组1例出现螺钉退钉现象。3组均无神经血管损伤、感染、内固定断裂和失效等并发症发生。3组术后开始工作时间、骨折愈合时间比较差异均无统计学意义(P> 0.05)。各项疗效评价指标:术后2周反置组均明显优于微型组和环抱器组(P<0.05);术后6个月3组比较差异均无统计学意义(P> 0.05)。结论 采用反置锁骨远端解剖型锁定钢板、双微型钢板与记忆合金环抱器治疗锁骨近端骨折均可获得满意的临床效果,但反置锁骨远端解剖型锁定钢板治疗更具早期优势。Objective To compare the effect of three kinds of internal fixation methods in the treatment of proximal clavicular fracture.Methods The 34 cases with proximal clavicular fractures were divided into inverted group(adopting inverted distal clavicular anatomic locking plate internal fixation,9 cases),mini-plate group(using double miniplates internal fixation,12 cases) and embracing device group(using memory alloy embracing device,13 cases). The postoperative complications,fracture healing conditions(postopetrative start working time and clinical fracture healing time) were recorded. The clinical outcomes were evaluated by the Constant-Murley shoulder function scores,visual analogue score(VAS),disabilities scores of the arm and shoulder and hand(DASH) and the shoulder joint activity range.Results All the patients were followed up for 12 ~ 18 months. In mini-plate group,there was 1 case of screw withdrawal. There were no significant complications such as neurovascular injuries,infection,internal fixation fracture and internal fixation failure. There were no significant differences in the start working time and fracture healing time among three groups(P> 0. 05). The various assessment indexes:the inverted group was significantly superior to the mini-plate group and the embracing device group at 2 weeks postoperation(P< 0. 05);and there were no statistical differences among three groups at 6 months after operation(P> 0. 05).Conclusions All three methods are effective methods for the treatment of proximal clavicular fractures,but the inverted distal clavicular anatomic locking plate is more superior in the early stage.

关 键 词：锁骨近端骨折 记忆合金环抱器 双微型钢板 反置 内固定术 

分 类 号：R683.1[医药卫生—骨科学] R687.32[医药卫生—外科学]