锁定钢板微创内固定治疗锁骨中段骨折的疗效研究  

Effectiveness of minimally invasive internal fixation with locking plates for mid-shaft clavicle fractures

作　　者：董文伟[1] 连伟杰 毛海蛟[1] 姚立炜 吴泽庭 DONG Wenwei;LIAN Weijie;MAO Haijiao;YAO Liwei;WU Zeting(Department of Traumatic Orthopaedics,the First Affiliated Hospital of Ningbo University,Ningbo Zhejiang,315000,P.R.China;The Affiliated Hospital of Medical School,Ningbo University,Ningbo Zhejiang,315000,P.R.China)

机构地区：[1]宁波大学附属第一医院创伤骨科,浙江宁波315000 [2]宁波大学医学院附属医院,浙江宁波315000

出　　处：《中国修复重建外科杂志》2024年第8期947-953,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：浙江省基础公益研究计划项目(LGF20H060008);宁波市科技服务业示范项目(2020F029)。

摘　　要：目的探讨锁定钢板微创内固定治疗锁骨中段骨折的疗效。方法2022年10月—2023年8月,采用锁定钢板微创内固定治疗28例锁骨中段骨折患者。男10例,女18例;年龄18~74岁,平均46.2岁。致伤原因:交通事故伤16例,运动损伤7例,其他伤5例。骨折根据Robinson分型标准:2A1型1例,2A2型6例,2B1型15例,2B2型6例。受伤至手术时间5 h~21 d,中位时间1.0 d。疼痛视觉模拟评分(VAS)为(8.1±1.6)分。术后3 d行VAS评分,并记录手术相关并发症发生情况;随访期间复查X线片观察骨折愈合情况,术后6个月行肩关节功能Constant-Murley评分,测量切口瘢痕长度(远、近端切口瘢痕长度总和)。结果手术均顺利完成,未出现锁骨下血管或神经损伤。术后切口均Ⅰ期愈合。术后3 d VAS评分为(1.2±0.7)分,与术前比较差异有统计学意义(t=8.704,P<0.001);1周后患肩基本无痛,患者生活可以自理。术后患者均获随访,随访时间12~20个月,平均13.3个月。X线片复查示术后2~4个月骨痂开始形成,平均2.7个月;无骨折端延迟愈合及不愈合,随访期间无内固定物松动、断裂发生。术后6个月,切口瘢痕长度1.1~1.8 cm,平均1.5 cm;患者无锁骨下区域及胸壁处皮肤麻木和不适感;肩关节功能Constant-Murley评分为93~100分,平均97.6分。结论锁定钢板微创内固定治疗操作简便、创伤小,术后效果好、患者满意度高,是治疗锁骨中段骨折良好手术方式。Objective To explore effectiveness of minimally invasive internal fixation with locking plates for mid-shaft clavicle fractures.Methods Between October 2022 and August 2023,28 patients with mid-shaft clavicle fractures were treated by minimally invasive internal fixation with locking plates.There were 10 males and 18 females with a mean age of 46.2 years(range,18-74 years).The fractures were caused by traffic accident in 16 patients,sports-related injury in 7 patients,and other injuries in 5 patients.According to Robinson classification,the fractures were classified as type 2A1 in 1 case,type 2A2 in 6 cases,type 2B1 in 15 cases,and type 2B2 in 6 cases.The interval between fracture and operation ranged from 5 hours to 21 days(median,1.0 days).The pain visual analogue scale(VAS)score was 8.1±1.6.The VAS score at 3 days after operation and the occurrence of complications after operation were recorded.During follow-up,X-ray films were re-examined to observe the healing of the fracture;the shoulder joint function was evaluated according to the Constant-Murley score at 6 months,and the length of the incision scar(total length of the distal and proximal incisions)was measured.Results All operations were successfully completed without any subclavian vascular or nerve damage.All incisions healed by first intention.The VAS score was 1.2±0.7 at 3 days after operation,and there was a significant difference in VAS score between pre-and post-operation(t=8.704,P<0.001).At 1 week after operation,the patient’s shoulder was basically painless,and they resumed normal life.All patients were followed up 12-20 months(mean,13.3 months).X-ray films showed that the bone callus began to form at 2-4 months after operation(mean,2.7 months).There was no delayed healing or non healing of the fracture,and no loosening or fracture of the internal fixators during follow-up.At 6 months after operation,the mean total incision length was 1.5 cm(range,1.1-1.8 cm);no patient complained of numbness or paresthesia on subclavicular region or anterio

关 键 词：微创手术 锁骨中段骨折 锁定钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]