小切口克氏针内固定和小切口钢板内固定治疗青年锁骨中段A型骨折的对比研究

Comparison of Kirschner wire internal fixation and minimally invasive percutaneous plate osteosynthesis for the treatment of typed-A midclavicular fractures in youth patients

目的：比较小切口克氏针内固定和小切口钢板内固定治疗青年锁骨中段A型骨折的临床疗效、安全性及卫生经济学指标。方法：回顾性分析接受手术治疗的52例青年锁骨中段A型骨折患者的病例资料,采用小切口克氏针内固定治疗者32例（A组）,采用小切口钢板内固定治疗者20例（B组）。比较2组患者的术中出血量、手术时间、骨折愈合时间、住院时间、住院费用、内固定取出费用、采用肩关节Neer评分评定的肩关节功能及并发症发生率。结果：①一般情况。52例患者均获随访,随访时间9-16个月,中位数11.5个月。2组患者的骨折愈合时间比较,差异无统计学意义[（10.70±2.20）周,（11.30±1.70）周t=0.942,P=0.351];A组患者术中出血量、手术时间、住院时间、住院费用及内固定取出费用均少于B组,差异有统计学意义[（20.32±17.51）mL,（40.73±15.11）mL,t=-5.860,P=0.000;（20.55±10.16）min,（50.12±17.26）min,t=-12.505,P=0.000;（6.63±1.27）d,（8.34±1.11）d,t=-4.182,P=0.000;（3 500.75±500.63）元,（7 500.74±300.85）元,t=-13.317,P=0.000;（1 100.23±350.93）元,（3 500.25±200.32）元,t=-16.708,P=0.000]。②肩关节功能。A组优18例、良12例、中2例,B组优10例、良9例、中1例。2组患者肩关节功能比较,差异无统计学意义（Z=-0.362,P=0.717）。③并发症发生率。A组术后2例患者出现针尾刺激症状,B组1例患者发生钢板远端螺钉拔出。2组患者并发症发生率比较,差异无统计学意义（χ2=0.000,P=1.000）。结论：小切口克氏针内固定和小切口钢板内固定都是治疗青年锁骨中段A型骨折的安全有效的治疗方法,但前者具有创伤小、费用低的优点。

Objective： To compare the clinical curative effects,safety and health economics indexes of Kirschner wire（ K- wire） internal fixation vs minimally invasive percutaneous plate osteosynthesis（ MIPPO） in the treatment of typed- A midclavicular fractures in youth patients. Methods： The medical records of 52 youth patients underwent operative treatment for typed- A midclavicular fractures were analyzed retrospectively. Thirty- two patients（ group A） were treated with K- wire internal fixation,while the others（ group B） were treated with MIPPO. Then the two groups were compared with each other in such parameters as blood loss,operative time,fracture healing time,hospitalization time,hospitalization costs,internal fixation removement costs,shoulder joint function evaluated by using shoulder- joint Neer scores and the incidences of complications. Results： The patients in the 2 groups were all followed up for 9- 16 months with a median of 11. 5 months. There was no statistical differences in the fracture healing time between the 2 groups（ 10. 70 ＋/- 2. 20 vs 11. 30 ＋/- 1. 70 weeks, t = 0. 942,P = 0. 351）. The blood loss,operative time,hospitalization time,hospitalization costs and internal fixation removement costs of group A were all less than those of group B（ 20. 32 ＋/- 17. 51 vs 40. 73 ＋/- 15. 11 mL,t =- 5. 860,P = 0. 000; 20. 55 ＋/- 10. 16 vs 50. 12 ＋/- 17. 26 min,t =- 12. 505,P = 0. 000; 6. 63 ＋/- 1. 27 vs 8. 34 ＋/- 1. 11 days,t =- 4. 182,P = 0. 000; 3 500. 75 ＋/- 500. 63 vs 7 500. 74 ＋/- 300. 85Yuan,t =- 13. 317,P = 0. 000; 1 100. 23 ＋/- 350. 93 vs 3 500. 25 ＋/- 200. 32 Yuan,t =- 16. 708,P = 0. 000）. Eighteen patients obtained an excellent result,12 good and 2 fair in group A,while 10 patients obtained an excellent result,9 good and 1 fair in group B. There was no statistical differences in the shoulder joint function between the 2 groups（ Z =- 0. 362,P = 0. 717）. The skin irritation caused by K- wire were found in two patients（ group A） after the surgery,while steel plate distal screw exposed was found in one patient（ group B） after the surgery. There was no statistical differences in the incidences of complications between the 2 groups（ χ2= 0. 000, P = 1. 000）. Conclusion： The therapy of K- wire internal fixation is similar to the therapy of MIPPO in curative effect and safety in the treatment of typed- A midclavicular fractures in youth patients,while the former has the merits such as less trauma and lower cost.