【摘要】 [目的]对比研究闭合复位锁定板外置固定与切开复位内固定治疗锁骨中段骨折的临床疗效。[方法]本院2014年1月～2016年12月收治锁骨中段骨折患者41例,其中应用闭合复位锁定板外固定16例(外置组),切开复位内固定25例(内置组),对两组手术时间、术中失血量、平均住院时间、平均愈合时间及VAS疼痛评分进行对比,采用Constant-Murley肩关节评分评价临床效果。[结果]手术时间、术中失血量及平均住院时间外置组少于内置组,差异有统计学意义(P<0.05)。术后3 d外置组VAS评分高于内置组,但差异无统计学意义(P>0.05)。内置组2例出现浅表切口感染,经换药和抗生素治疗后感染控制。41例患者随访6～18个月,平均(14.05±3.18)个月。外置组骨折临床愈合时间显著短于内置组,差异有统计学意义[(3.250±0.856)个月vs (4.160±1.214)个月,P<0.05]。外置组1例,内置组3例出现骨折延迟愈合,经三角巾悬吊保护下功能锻炼骨折愈合。末次随访时两组患者均获得满意的功能恢复,两组间VAS评分和Constant-Murley肩关节评分的差异均无统计学意义(P>0.05)。[结论]闭合复位锁定板外置固定可取得与切开复位内固定相同的疗效,但闭合复位锁定板外固定具有手术时间短、出血量少、平均住院及愈合时间短的优势。更多还原

【Abstract】 [Objective] To compare the clinical outcomes of locking plate used as closed reduction and external fixation versus open reduction and internal fixation for midshaft clavicular fracture. [Methods] From January 2014 to December 2016, 41 patients with mid-clavicular fractures were surgically treated. Of them, 16 patients had closed reduction and external fixation with locking plate(the external group), while the remaining 25 patients received open reduction and internal fixation with locking plate(the internal group). The operation time, intraoperative blood loss, hospital stay, and bony healing time, as well as the visual analogue scale(VAS) of pain and Constant-Murley score were compared between the two groups. [Results] The external group consumed statistically shorter operation time,took significantly less intraoperative blood loss and spent considerably shorter hospital stay than the internal group(P<0.05). The external group got higher VAS than the internal group at 3 days postoperatively despite no a statistical difference between them(P>0.05). Superficial wound infection occurred in 2 patients of the internal group, which was cured after dressing changing and antibiotic therapy. All the 41 patients were followed up for 6 to 18 months with an average of(14.56±2.78) months. The external group proved statistically superior to the internal group regarding to clinical bone healing time [(3.250±0.856) months vs(4.160±1.214) months, P<0.05]. Three patient in the external group and 1 patients in the internal group had delayed bone union, which got healing after protective rehabilitation exercise. At the latest follow up, all patients in both groups achieved satisfactory outcomes, with no statistical differences in VAS and Constant-Murley score between them(P>0.05). [Conclusion] Although locking plate used as both external fixation and internal fixation obtain similar clinical outcomes for midshaft clavicular fracture, the external fixation take advantages of shorter operation time, less blood loss, shorter hospital stay and faster bone healing over the internal fixation.更多还原