钛制髓内钉与克氏针髓内固定治疗锁骨中段骨折的效果比较

Comparison of therapeutical effects between titanium elastic nail and Kirschner wire in treating mid-shaft clavicle fractures

背景:目前克氏针固定是锁骨中段骨折髓内固定常用的治疗方法,但仍有一定比例的并发症发生。钛制弹性髓内钉是近年来国际流行的一种治疗儿童长骨骨折的方法。目的:比较钛制弹性髓内钉与克氏针二种微创方法治疗锁骨中段骨折的疗效,为改进锁骨中段骨折的治疗方法提供临床依据。方法:手术治疗46例锁骨中1/3骨折,其中钛制弹性髓内钉固定15例,克氏针固定31例。比较两种术式的手术时间、住院时间、骨折愈合时间、并发症发生情况以及术后3周内患肩功能锻炼情况。结果与结论:钛制弹性髓内钉固定骨折愈合时间比克氏针固定组提前(P<0.05),患肩可早期积极功能锻炼且术后3周肩关节活动度接近健侧,而克氏针需前臂吊带悬吊制动4周以上,不能进行早期功能锻炼。钛制弹性髓内钉组退钉1例,钉尾刺激征1例,未发生骨不连以及骨折端旋转等并发症;克氏针组克氏针松动退针7例,针尾刺激征6例,针尾炎性窦道4例,2例骨折移位、骨不连。结果表明,钛制弹性髓内钉治疗锁骨中段骨折具有愈合时间、治愈率高、并发症少,以及可早期患肩功能锻炼等优点。因此,钛制弹性髓内钉治疗锁骨中段骨折是一种更佳的选择。

BACKGROUND：In recent years,fixation in bone marrow,such as Kirschner wire,has got satisfactory effects in most of patients with mid-shaft fracture of clavicle.However,there are still some complications in part of patients.Titanium elastic nail（TEN） is a common method for treating child long bone fractures.OBJECTIVE：To compare TEN and Kirschner wire in treat the mid-shaft clavicle fractures,so as to provide clinical evidences for the improvement of treatment of mid-shaft clavicle fractures.METHODS：A total of 46 cases with middle 1/3 of clavicular fracture were underwent surgical treatment,15 cases using TEN,31 cases using Kirschner wire.Operation time,hospitalization,healing time of fracture,complications and shoulder function recovery at 3 weeks after surgery were compared.RESULTS AND CONCLUSION：Compared with Kirschner wire group,TEN group had better results in healing time of fractur（P 0.05）;patients in the TEN group could perform early active functional exercises,and the range of motion of affected shoulder was almost the same compared with normal side at 3 weeks after surgery,while Kirschner wire group need to caging the shoulder over 4 weeks and forbid the early active functional exercises.Occurrence of complications：1 case with nail quit 1 case with nail tail irritation without skin ulceration,no fracture nonunion and fracture stump rotation were found in the TEN group.7 cases with wire loose,6 cases with wire tail irritations,4 cases with wire tail inflammatory sinus tract,2 cases with fracture displaced or nonunion（changed for reconstruction plate） in the Kirschner wire group.Compared with Kirschner wire,TEN have advantages of less healing time,high recovery rate,less complications,early functional exercises after surgery.Therefore,TEN is a better choice for patients with mid-shaft clavicle fractures.