闭合复位经皮穿针内固定在中段锁骨骨折患者中的应用  

The effect of closed reduction percutaneous steel pin internal fixation in patients with mid-clavicular fractures

作　　者：赵朝锋[1] 莫基浩[1] 王笑千 薛继强 韩卢丽[1] ZHAO Chaofeng;MO Jihao;WANG Xiaoqian(Department of Manual Orthopedics,Henan Luoyang Orthopedics Hospital,Henan,Luoyang,471002,China)

机构地区：[1]河南省洛阳正骨医院手法正骨科,河南洛阳471002

出　　处：《实用手外科杂志》2024年第4期507-510,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨闭合复位经皮穿针内固定治疗中段锁骨骨折(Clavicular fracture,CF)患者的临床疗效。方法收集河南省洛阳正骨医院2020年1月-2022年10月收治的130例中段锁骨骨折患者病例资料,按手术方案不同分成A组65例、B组65例。A组接受闭合复位经皮穿针内固定治疗,B组接受常规切开复位内固定(Open reduction and internal fixation,ORIF)治疗。对比两组手术指标(骨折愈合时间、手术耗时、术中失血量、住院时间)、术后3个月手术效果、术前、术后1个月、3个月骨代谢指标[骨钙素N端中分子片段(NMID)、Ⅰ型前胶原氨基末端前肽(PINP)、β-胶原降解产物(β-CTX)]水平及术后3个月内并发症发生率。结果与B组相比,A组骨折愈合时间、手术耗时、住院时长更短,术中失血量更低(P<0.05);A组手术优良率93.85%(61/65)与B组96.92%(63/65)相比,差异无统计学意义(P>0.05);术后1个月、3个月A组血清NMID水平较B组高,P1NP、β-CTX水平较B组低(P<0.05);与B组并发症总发生率12.31%(8/65)相比,A组1.54%(1/65)更低(P<0.05)。结论闭合复位经皮穿针内固定与常规切开复位内固定治疗中段CF手术效果相当,但前者更有助于优化手术指标,促进骨折愈合,减少并发症。Objective To investigate the outcome of closed reduction percutaneous steel pinning for the treatment of patients with mid-clavicular fractures(CF).Methods The case data of 130 patients with mid-segment CF(January 2020 to October 2022)in our hospital were collected and divided into group A(n=65)and group B(n=65)according to different surgical protocols.Group B received conventional open reduction and internal fixation(ORIF),and group A received closed reduction and percutaneous pin fixation.The operation indexes(fracture healing time,operation time,intraoperative blood loss,hospitalization time),operation effect 3 months after operation,bone metabolism indexes[[N-terminal intermediate molecular fragment of osteocalcin(nmid),N-terminal pro peptide of type I procollagen(PINP),[N-terminal intermediate molecular fragment of osteocalcin(MMID)]before operation,1 month and 3 months after operation]were compared between two groups β-Collagen degradation products(β-CTX)]level and the incidence of complications within 3 months after operation.Results Compared with group B,group A had shorter fracture healing time,operative elapsed time,length of hospital stay,and lower intraoperative blood loss(P<0.05);there was no significant difference between group A excellent surgical rate of 93.85%(61/65)and group B 96.92%(63/65)(P>0.05);Higher serum NMID levels and lower P1NP andβ-CTX levels appeared in group A compared to group B 1 month and 3 months postoperatively(P<0.05).serum Cor,E and NE levels were higher in group A than in group B 1 d and 3 d postoperatively(P<0.05);and the overall complication rate was lower in group A at 1.54%(1/65)compared with group B at 12.31%(8/65)(P<0.05).Conclusion The surgical results of closed reduction percutaneous needle internal fixation and ORIF for patients with mid-segment CF are comparable,but the former is more helpful in optimizing surgical indications,promoting fracture healing,reducing complications,and producing less stress injury to the organism.

关 键 词：中段锁骨骨折 闭合复位经皮穿针 切开复位 骨代谢 

分 类 号：R687.3[医药卫生—骨科学]