钛制弹性钉与重建钢板在治疗移位锁骨中段骨折中的临床疗效比较

Comparison of titanium elastic nail and reconstruction plate in treatment of displaced midshaft clavicular fractures

目的 比较钛制弹性钉（TEN）与重建钢板（RP）治疗移位锁骨中段骨折的疗效.方法 2005年1月至2007年7月,对采用TEN或RP治疗且获随访的141例锁骨中段移位骨折患者的资料进行回顾性分析,其中57例患者采用TEN治疗（TEN组）,84例患者用3.5 mm RP治疗（RP组）.比较两组患者的一般情况、术后并发症、术后6个月及术后2年Constant评分及臂、肩、手功能障碍（DASH）评分.结果 TEN组患者获24～41个月（平均30个月）随访,RP组患者获28～48个月（平均32个月）随访.影像学显示TEN组骨折愈合时间平均为（12.4±3.4）周,RP组平均为（14.4±3.7）周.两组患者骨不连和成角畸形短缩、内置物失败、感染、短暂性神经丛刺激症、内置物移位、皮肤刺激症等并发症的发生情况,差异无统计学意义（P＞0.05）.TEN组有17例内置物移位,但程度轻,多数患者无临床症状.术后6个月随访时,TEN组患者DASH评分明显低于RP组（P＜0.05）,而Constant 评分明显高于RP组（P＜0.05）.术后2年时,两组患者的DASH评分和Constant评分差异无统计学意义（P＞0.05）.TEN组患者对术后肩部外形及综合结果较RP组更满意.结论 与RP相比,TEN治疗移位的锁骨中段骨折在术后早期功能锻炼及功能恢复方面有明显的优势.术后早期TEN组患者对肩部外形及术后综合结果方面更为满意.

Objective To compare the clinical results of titanium elastic nail （TEN） and reconstruction plate （RP） in the treatment of displaced midshaft clavicular fractures. Methods From January 2005 to July 2007, 141 patients with displaced midshaft clavicular fractures were treated in our hospital with TEN or RP fixation. We compared the clinical results of the 2 groups in terms of general condition, postoperative complications and disabilities of the arm, shoulder and hand （DASH） and Constant Scores at 6 and 24 months postoperatively. Results The mean radiographic bone union time for TEN patients was （ 12.4 ± 3.4） weeks and （ 14. 4 ± 3.7） weeks for RP patients. There was no significant difference between the 2 groups in nonunion or malunion. Mild migration of implants occurred in 17 TEN patients, but without any symptom in most cases. The DASH scores were significantly lower for TEN group than for RP group at 6 months （ P 〈0.05 ）, while the Constant scores were significantly higher （ P 〈 0. 05）. There was no significant difference at 24 months between the 2 groups in DASH or Constant scores （ P 〉 0. 05）. TEN Patients were more satisfied with their cosmetic appearance and overall outcome than RP patients. Conclusion TEN fixation of displaced midshaft clavicular fractures allows for a more rapid return to daily activities, better functional outcome, higher patient satisfaction and more cosmetically satisfactory appearance than RP fixation. The complication rates of TEN and RP are similar.