锁骨中段移位骨折的手术治疗与非手术治疗比较

Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures

[目的]比较非手术治疗与切开复位钢板固定治疗锁骨中段移位骨折的疗效。[方法]对2001年3月到2005年12月收治110例单侧锁骨中段完全移位骨折的随访资料进行回顾分析。手术组62例，采用切开复位钢板螺钉固定，男53例，女9例，年龄21—51岁，平均33．5岁。非手术组48例，采用手法复位“8”字绷带固定，男33例，女15例，年龄19～50岁，平均33岁。110例患者在治疗后6周、3、6、12个月，对其临床表现、肩关节评分、并发症发生情况及X线表现进行评价。[结果]全部病例随访1年，肩关节评分在随访各时相点手术组要比非手术组高，有显著差异（P〈0．01）。平均骨愈合时间手术组为16．4周而非手术组为28．4周，有显著差异（P〈0．01）。非手术组有7例骨不愈合及9例骨畸形愈合，比手术组高，差异有显著性（P〈0．05，P〈0．01）。其他与钢板有关并发症两组间无明显差异。[结论]切开复位钢板固定治疗锁骨中段移位骨折是安全有效的，减少骨折畸形愈合、骨不愈合的发生，可使肩关节功能早日恢复。

[ Objective ] To compare the outcome and complication rates following nonoperative and those after ptate fixation of displaced midshaft clavicular fractures. [ Method] Between March 2001 and December 2005, the data of 110 patients with a displaced midshaft fracture of clavicle were retrospective analyzed. Among them,62 patients were treated with plate fixation, including 53 male and 9 female patients aged 33.5 years old averagely. 48 patients were treated with closed reduction and a figure-of- eight bandage applied, including 33 male and 15 female patients aged 33 years old averagely. Following enrollment in the study, the patients were seen at six weeks and at three, six, and twelve months. Assessment included standardized clinical evaluation, completion of the Constant shoulder score, complication and plain radiographs. Radiographic union was defined as complete cortical bridging between proximal and distal fragments on radiograph. [ Result] All patients completed one year of follow-up. Constant shoulder score were significantly improved in the operative fixation group at all time-points （P 〈 0.01 ）. The mean time to radio- graphic union were 28.4 weeks in the nonoperative group compared with 16.4 weeks in the operative group（ P 〈 0.01 ）. There were two nonunions in the operative group compared with seven in the nonoperative group（ P 〈 0.05 ）. Malunion developed in nine patients in the nonoperative group and none in the operative group （P 〈 0.01 ）. No significant difference was found on the other complications with hardware- related between two groups. [ Conclusion] This study supports primary plate fixation of completely displaced midshaft clavicular fractures in active adult patients. Operative fixation of a displaced fracture of the clavicular shaft resuits in improved functional outcome and a lower rate of malunion and nonunion compared with nonoperative treatment at one year of follow-up.