重建钢板上置和前置治疗老年锁骨中段骨折的疗效分析

Superior versus anterior reconstruction plate internal fixation for middle clavicular fractures in old patients： a comparative study

目的比较重建钢板上置和前置治疗老年锁骨中段骨折的疗效。方法分别用重建钢板上置法、重建钢板前置法治疗锁骨中段骨折39例，其中男19例，女20例；平均年龄66．7岁。记录并比较两组手术时间、术中出血量、骨折愈合时间；术后半年及末次随访时按Constant评分评价患侧肩关节功能。结果所有患者均获得随访，时间10～32个月，平均18．7个月。重建钢板上置组与前置组在骨折愈合时间、术后半年、末次随访时肩关节Constant评分方面差异无统计学意义（P〉0．05）；重建钢板上置组并发症发生率明显高于前置组；重建钢板前置组在手术时间及术中出血量方面明显优于上置组（P〈0．05）。结论对于老年锁骨中段骨折，重建钢板上置和前置法均可获得较佳疗效，但重建钢板前置能明显缩短手术时间，减少术中出血量，并发症少，是一种可靠的治疗老年锁骨中段骨折的方法。

Objective To compare the effect of anterior and superior reconstruction plate internal fixation in treatment of middle clavicular fractures in the old patients. Methods Thirty-nine old patients with middle clavicular fractures received anterior and superior reconstruction plate internal fixation treatment, respectively. There were 19 males and 20 females at average age of 66.7 years. The operation time, intraoperative blood loss and healing time were observed and compared in two groups. According to the Constant scoring system, shoulder functional evaluation was made at half a year after operation and the latest follow-up. Results All the patients were followed up for 10-32 months （average 18.7 months）. Of the two groups, there was no statistical significance in aspects of healing time and Constant score at half a year after operation and the latest follow-up （P 〉 0.05）. The complication of superior reconstruction plate internal fixation group was significant higher than that of anterior reconstruction plate internal fixation group, while the anterior reconstruction plate internal fixation group had shorter operation time and less intraoperative blood loss in comparison with the superior reconstruction plate internal fixation group （ P 〈 0.05 ）. Conclusion As for the middle clavicular fractures in the old patients, both anterior and superior reconstruction plate internal fixation can obtain satisfactory curative effect. With shorter operation time, less intraoperative bleeding and less complications, anterior reconstruction plate internal fixation is a much reliable treatment for middle clavicle fractures in the old patients and deserves wider application.