【摘要】 [目的]探讨钢板前置内固定治疗青年锁骨骨折的临床疗效。[方法]回顾性分析2013年4月~2015年5月32例行切开复位锁骨前置钢板内固定术的青年锁骨骨折病例,并与同时期34例青年锁骨骨折上置钢板内固定患者作对照。术中对游离较大骨折块以拉力螺钉固定、较小骨块以粗丝线固定。术后4周、8周、12周、6个月及12个月进行随访,比较两组在手术时间、总出血量、并发症、骨折愈合、内固定、肩关节功能及钢板对皮肤顶压等情况。[结果]所有患者术后均获随访,时间12~36月,平均15.4个月。患者均无血管神经损伤、切口感染坏死及血气胸等围手术期并发症。前置钢板组的手术时间平均(50.2±14.5)min、总出血量平均(99.1±25.3)ml、骨折愈合时间(16.2±8.3)周、术后12个月肩关节功能Constant平均评分(87.3±4.5)分;上置钢板组的手术时间平均(47.6±16.5)min、总出血量平均(110.0±27.1)ml、骨折愈合时间(15.0±5.5)周、术后12月肩关节功能Constant评分平均(89.8±6.5)分,两组上述指标比较差异无统计学意义(P>0.05)。上置钢板组1例术后2个月出现骨折轻度上下移位,内固定部分松动,局部制动后术后6个月轻度畸形愈合,3例女性患者术后1个月起诉钢板顶压皮肤突出引起生理及心理不适。前置钢板组1例延迟愈合,相对制动后术后10个月愈合,无钢板顶压皮肤导致的生理及心理不适患者。[结论]前置钢板内固定治疗青年锁骨骨折在获得满意临床疗效的同时能有效减少钢板顶压皮肤导致的不适及促进美观,是治疗青年锁骨骨折的一种良好选择方法。更多还原

【Abstract】 [Objective] patients. [Methods] From April 2013 to May 2015,32 young patients with displaced clavicle fracture underwent open reduction and internal fixation with anterior plate placement. Meanwhile,other 34 cases were operated with superior plate placement as the control group. In addition to the plate fixation,the large bone fragments were fixed by lag screws while the small fragments fastened with silk suture cerclage. The operation time,intraoperative blood loss,mid-postoperative complications,fractures heal, internal fixations,shoulder function and plates irritation to the skin were observed and compared between the two groups. [Results] All the patients were followed up for 12 to 36 months with an average of 15.4 months. No neurovascular injury, infection of incision or necrosis,hemopneumothorax and other perioperative complications was noted in any patient.Compared the anterior plate group with the superior plate group,the average operation time was(50.2±14.5) minutes versus(47.6±16.5) minutes,the average blood loss was documented(99.1±25.3) ml versus(110.0±27.1) ml,the average fracture healing time was recorded(16.2±8.3) weeks versus(15.0±5.5) weeks,additionally,shoulder functional evaluation at12 months after operation proved(87.3±4.5) versus(89.8±6.5) according to the Constant scoring system. There were no statistically significant differences in any of above mentioned criteria between the two groups(P>0.05). In the superior plate group,mild superoinferior fracture displacement and partial fixation loosening was noted at 2 months postoperatively in a patient,who got mild malunion of the fracture at 6 months postoperatively following limited immobilization. Plate irritation and related psychological discomfort was noted in 3 female patients in the superior plate group at 1 month after operation. By contrast,only a patient had delayed union which healed 10 months after operation by local immobilization, no irritation or psychological discomfort was found in any of patients in the anterior plate group. [Conclusion] Anterior plate internal fixation for clavicle fracture can effectively reduce physical andpsychological discomfort and promote cosmetic appearance, therefore get satisfactory clinical outcome. It is an effective surgical method for displaced clavicular fracture in young patients.更多还原