【摘要】 目的探讨克氏针临时髓内固定联合锁定解剖钢板治疗粉碎性锁骨骨折的临床疗效。方法 2007年2月~2014年2月采用克氏针临时髓内固定联合锁定解剖钢板微创治疗粉碎性锁骨骨折52例(微创组),与同期采用重建钢板治疗粉碎性锁骨骨折60例(传统组)进行比较,比较2组手术时间、术中出血量、切口总长度、术后24 h疼痛VAS评分、骨折愈合时间、术后并发症发生率、术后3个月患肩Neer评分。结果 112例粉碎性锁骨骨折均顺利完成内固定术。微创组手术时间明显短于传统组[(45.0±7.5)min vs.(62.0±15.5)min,t=-7.208,P=0.000],术中出血量明显少于传统组[(25.0±16.5)ml vs.(63.0±19.7)ml,t=-10.968,P=0.000],切口总长度明显短于传统组[(6.4±0.8)cm vs.(10.3±1.7)cm,t=-15.147,P=0.000],术后24 h疼痛VAS评分明显低于传统组[(1.9±0.5)分vs.(4.4±0.4)分,t=-29.378,P=0.000],骨折愈合时间明显短于传统组[(9.3±1.2)周vs.(11.4±1.3)周,t=-8.834,P=0.000],并发症发生率明显低于传统组[0 vs.8.3%(5/60),Fisher精确检验,P=0.041]。112例随访12~48个月,平均14个月,2组术后3个月肩关节功能评分差异无显著性(P>0.05)。结论克氏针临时髓内固定联合锁定解剖钢板微创治疗粉碎性锁骨骨折具有创伤小、手术时间短、复位容易、固定可靠、骨折愈合时间短、术后并发症发生率低等优点,是一种较理想的治疗方法。更多还原

【Abstract】 Objective To investigate the clinical effect of minimally invasive treatment of comminuted fracture of the clavicle with temporary intramedullary interlocking nail and locking anatomical plate. Methods From February 2007 to February 2014,52 cases of comminuted fracture of the clavicle were treated with the temporary intramedullary fixation plus locking anatomical plate( minimally invasive group). Another 60 cases who received the surgery via a traditional incision in the same period were set as the control group. The operation time,blood loss,the length of incision,24-hour VAS scores,fracture healing time,incidence of postoperative complications,and Neer scores after 3 months were compared between the two groups. Results The surgery was successfully operated in all the 112 cases. As compared to the traditional group,the minimally invasive group had shorter operative time [( 45. 0 ± 7. 5) min vs.( 62. 0 ± 15. 5) min,t =-7. 208,P = 0. 000],less blood loss [( 25. 0 ± 16. 5) ml vs.( 63. 0 ± 19. 7)ml,t =-10. 968,P = 0. 000],shorter incision length [( 6. 4 ± 0. 8) cm vs.( 10. 3 ± 1. 7) cm,t =-15. 147,P = 0. 000],lower VAS pain score [( 1. 9 ± 0. 5) point vs.( 4. 4 ± 0. 4) point,t =-29. 378,P = 0. 000],and shorter fracture healing time [( 9. 3 ±1. 2) weeks vs.( 11. 4 ± 1. 3) weeks,t =-8. 834,P = 0. 000]. The complication rate in the minimally invasive group was significantly lower than that in the traditional group [0 vs. 8. 3%( 5/60),Fisher’s exact test,P = 0. 041]. All the patients were followed up for 12-48 months( mean,14 months). There was no significant difference in shoulder function after the operation after 3months( P > 0. 05). Conclusions The minimally invasive treatment of comminuted fracture of the clavicle with the temporary intramedullary interlocking nail and locking anatomical plate has advantages of less trauma,shorter operative time,easy reduction,reliable fixation,shorter fracture healing time and lower complication rate. It is a good treatment method.更多还原