成人锁骨中段有移位骨折手术与保守治疗的病例对照研究

Surgical and nonsurgical treatment of clavicular midpiece fracture in adults:a case-control study

目的:比较手术与保守方法治疗锁骨中段移位骨折。方法:回顾性分析2002年9月至2011年9月收治成人锁骨中段有移位骨折254例,男188例,女66例;年龄19～62岁,平均39.3岁;横行骨折38例,斜行骨折71例,粉碎性骨折145例;均为新鲜单一骨折。其中保守治疗组127例,男96例,女31例,平均年龄(40.1±6.02)岁,采用手法复位"∞"形绷带外固定;手术治疗组127例,男92例,女35例,平均年龄(39.0±5.11)岁,采用切开复位重建钢板内固定。对比两组外观满意度、治疗费用和并发症的发生率,根据韩良平等制定的标准进行疗效评定。结果:所有病例获得随访,时间8～10个月,平均9.8个月。手术治疗组中优110例,良12例,可3例,差2例;保守治疗组中优62例,良28例,可37例;手术治疗组疗效优于保守治疗组。保守治疗组外观满意度高于手术治疗组,保守治疗组治疗费用及并发症低于手术治疗组。结论:成人锁骨中段移位骨折应该综合分析选择治疗方案,首先选择非手术治疗,严格把握手术指征。

Objective：To compared surgical and nonsurgical treatment of clavicular midpiece fracture.Methods：From September 2002 to September 2011,254 adult cases of displaced midshaft clavicle fractures were retrospective analyzed,including 188 males and 66 females who ranged in age from 19 to 62 years（mean 39.3 years）.There were 38 cases of transverse fracture,71 cases of oblique fracture,and 145 cases of comminuted fracture.All cases were fresh single fractures.According to the treatment methods,these patients were divided into conservative group and surgical group.In conservative group,127 patients（96 male and 31 female;mean age 40.1±6.02） were treated by manipulative reduction and fixation with ＂∞＂ shaped bandage.In surgical group,96 patients（92 male and 35 female;mean age 39.0±5.11） were treated by open reduction and internal fixation with reconstruction plates.Appearance satisfaction,the cost of treatment and the incidence of complications were compared between the two groups.Therapeutic efficacy was evaluated according to Han＇s standard.Results：All patients of both groups were followed up for 8-10 months（mean 9.8 months）.In surgical group,the curative effect was excellent in 110 cases,good in 12 cases and fair in 3 cases;in conservative group,the curative effect was excellent in 62 cases,good in 28 cases and fair in 37 cases.The therapeutic efficacy in surgical group was better than that in conservative group.The appearance satisfaction of conservative group was higher than that of surgical group.The cost of treatment and complications were lower in conservative group than those in surgical group.Conclusion：Treatment modalities for adult clavicle fractures should be selected on the basis of comprehensive analysis.Non-surgical treatment should be the treatment of choice,and indication for surgical treatment should be controlled strictly.