钛制弹性髓内钉治疗成人锁骨中段骨折的临床评价

Clinical evaluation of titanium elastic nailing for midclavicniar fractures

目的探讨钛制弹性髓内钉（TEN）治疗锁骨中段骨折的临床疗效。方法2005年2月至2007年2月收治41例移位的成人锁骨中段骨折，均在伤后1周内行有限切开复位，自锁骨胸骨端插入TEN内固定。结果41例患者术后获平均14．5个月（7．24个月）随访。所有骨折均获愈合，平均愈合时间为1．8个月。术后3d的主观疼痛较术前有显著降低（t=3．26，P〈0．01）。肩关节活动度：术前前屈平均25．6°，术后2周前屈平均95°，差异有统计学意义（t=2．81，P〈0．01）；术前外展平均23．5°，术后2周外展平均88．5°，差异有统计学意义（t=2．93，P〈0．01）。平均7．2个月（5．4～9．5个月）后取出TEN，没有出现再骨折。最后随访时，肩关节的Constant评分平均为95．2分（86．5—97．0分），DASH评分平均为2．5分（0．5～8．0分），肩关节活动度：前屈平均155°，外展平均160°。1例出现TEN远端穿出骨皮质。结论TEN治疗成人锁骨中段明显移位骨折是一种安全、微创的手术方法。

Objective To evaluate the clinical effects of titanium elastic nailing （TEN） for midclavicular fractures. Methods In the period from February 2005 to February 2007, 41 cases of displaced midclavicular fractures were treated by open reduction and internal fixation with TEN inserted at the sternal end of the clavicle. Results A mean follow-up of 14.5 months revealed fracture union in all cases with a mean healing time of 1.8 months. The mean subjective pain 3 days postoperatively was significantly lower than that on the day before surgery （ P 〈 0.01） . The mean range of motion 2 weeks postoperatively was improved compared with the day before surgery （ P 〈 0.01 ） . The nails were removed in all patients after a median of 7.2 （5.4 to 9. 5） months postoperatively. No patient sustained a re-fracture after nailing removal. The mean DASH score was 2.5 （0. 5 to 8.0） points and the mean Constant score 95.2 （86. 5 to 97. 0） points eventually. Conclusion Fixation of displaced midclavicular fractures with titanium elastic nailing is a Safe and minimally invasive surgical technique.