钛制弹性髓内钉与重建钢板应用于锁骨中段骨折髓内外固定的比较

Titanium elastic nail versus reconstruction plate for mid-shaft clavicle fracture

背景:锁骨中段骨折手术治疗的主要方法包括髓内钛制弹性髓内钉与髓外钢板置入内固定,不同的固定方式对患者创伤、治疗成本及固定后最终临床效果影响很大,因此,选择合理的内固定方式至关重要。目的:比较钛制弹性髓内钉与重建钢板置入内固定治疗锁骨中段骨折的临床效果。方法:选择锁骨中1/3段骨折患者42例,其中钛制弹性髓内钉髓内置入内固定19例,重建钢板髓外置入内固定23例。比较两种置入内固定的手术时间、住院时间、出血量、皮肤切口长度、骨折愈合时间、并发症发生情况及术后患肩功能恢复情况。结果与结论:钛制弹性髓内钉组手术时间、住院时间、出血量、皮肤切口长度及骨折愈合时间均优于重建钢板组(P<0.05)。两者术后患者肩功能恢复情况无差异(P>0.05)。钛制弹性髓内钉组发生退钉1例,钉尾刺激征1例。重建钢板组发生螺丝钉松动1例。所有病例均未发生手术感染。说明钛制弹性髓内钉与重建钢板置入内固定都是锁骨中段骨折治疗的良好方法,但在相同疗效的前提下,钛制弹性髓内钉置入固定可以减少组织创伤,缩短疗程,尽早恢复功能。对于复杂型骨折,最好还是选用重建钢板置入内固定。

BACKGROUND：The internal fixation methods of mid-shaft clavicle fracture mainly include intramedullary fixation and extramedullary fixation.The different internal fixation methods result in significant different influences on patient trauma,treatment cost,and the final clinical effects.Therefore,it is very important to choose reasonable internal fixation methods for curing mid-shaft clavicle fracture.OBJECTIVE：To compare the clinical effects of internal fixation for mid-shaft clavicle fracture using titanium elastic nail（TEN） or reconstruction plate.METHODS：A total of 42 cases with middle 1/3 of clavicular fracture were tre ated,including19 using TEN and 23 using reconstruction plate.Operation time,hospitalization,amounts of bleeding,length of skin incision,healing time of fracture,complications and shoulder function recovery after surgery were compared between these two groups.RESULTS AND CONCLUSION：The TEN group had better results compared with reconstruction plate group in operation time,hospitalization,the amount of bleeding,length of skin incision,healing time of fracture（P 0.05）.There was no significant difference between the two groups in shoulder function recovery（P 0.05）.Occurrence of complications as follow：In TEN group,nail quit in 1 case,nail tail irritation in 1 case（no skin ulceration）,no fracture nonunion and fracture stump rotation were found;In Reconstruction group,nail loose in 1 case,no infection,plate broken,fracture nonunion were found.No infections were found in all cases.Both methods are good choices for fixation of mid-shaft clavicle fracture.But TEN would be the best choice in terms of tissue trauma,treatment time,function recovery and expense.However,reconstruction plate fixation is certainly a better choice in complicate fracture.