解剖钢板和克氏针内固定治疗对锁骨中段骨折患者肩关节功能及并发症的影响比较

Impact of Internal Fixation with Anatomical Plate and Internal Fixation with Kirschner Wire on Shoulder Function and Complications in Patients with Clavicle Fracture at the Intermediate Piece

目的:探讨解剖钢板和克氏针内固定治疗对锁骨骨折患者肩关节功能及并发症的影响。方法:回顾性分析2014年6月-2016年1月本院收治的70例锁骨中段骨折患者的临床资料,根据内固定方法的不同,分为解剖钢板组(n=36)和克氏针组(n=34)。解剖钢板组接受解剖钢板内固定术治疗,克氏针组接受克氏针内固定术治疗。记录两组患者手术相关指标,随访6个月,观察两组术后并发症的发生情况,于术前和术后6个月采用Constant肩关节评分对两组的肩关节功能进行评价。结果:克氏针组的手术时间、切口长度和术中出血量分别为(25.48±1.31)min、(4.68±0.94)cm和(35.72±5.37)m L,均优于解剖钢板组的(40.72±8.46)min、(7.25±1.08)cm和(62.54±12.28)m L,差异均有统计学意义(P<0.001)。解剖钢板组的骨折愈合时间为(10.14±2.33)周,短于克氏针组的(12.87±2.54)周,差异有统计学意义(P<0.001)。解剖钢板组术后6个月的Constant评分为(94.52±5.64)分,高于克氏针组的(83.79±8.13)分,差异有统计学意义(P<0.01)。解剖钢板组的并发症发生率为8.33%,低于克氏针组的26.47%,差异有统计学意义(P<0.05)。结论:克氏针内固定手术时间短,切口小,但并发症较多,解剖钢板内固定治疗锁骨骨折,更有利于骨折愈合和肩关节功能的恢复,且并发症少,安全有效,值得应用于临床。

Objective： To discuss the impact of internal fixation with anatomical plate and internal fixation with kirschner wire on shoulder function and complications in patients with clavicle fracture at the intermediate piece.Method： A total of 70 patients with clavicle fracture at the intermediate piece in our hospital from June 2014 to January 2016 were retrospectively analyzed, according to the different internal fixation methods, they were divided into the anatomical plate group （ n=36 ） and the kirschner wire group （ n=34 ） .The anatomical plate group was accepted with internal fixation with anatomical plate, the kirschner wire group was accepted with internal fixation with kirschner wire.The related operation indices were recorded, followed-up for half a year, observed complication occurrence of the two groups, evaluated the shoulder function with Constant shoulder joint scoring system before operation and in 6 months after operation.Result： The operation time, incision length and intraoperatve blood soss of the kirschner wire group were （ 25.48± 1.31 ） min,（ 4.68 ± 0.94 ） cm and （ 35.72 ± 5.37 ） mL, all better than （ 40.72 ±8.46 ） min, （ 7.25± 1.08 ） cm and （ 62.54 ± 12.28 ） mL of the anatomical plate group, the differences were statistically significant （P〈0.001） .The fracture healing time of the anatomical plate group was （ 10.14± 2.33 ） weeks, which shorter than （ 12.87± 2.54 ） weeks of the kirschner wire group, the difference was statistically significant （ P〈0.001 ） .6 months after operation, the score of Constant of the anatomical plate group was （ 94.52± 5.64 ）, which was higher than （ 83.79± 8.13 ） of the kirsehner wire group, the difference was statistically significant （ P〈0.01 ） .The complication occurrence rate of the anatomical plate group was 8.33%, which was lower than 26.47% of the kirschner ~re group, the difference was statistically significant （ P〈0.05 ） . Conclusion： Kirsehner wire internal fixation operation time is short, small incision, but more complications, internal fmation with anatomical plate to apply to patients with clavicle fracture at the intermediate piece is good to fracture healingand recovery of shoulder function with less complications, it is worthy of clinical use.