股骨颈空心螺钉髓内固定与重建钢板治疗成人锁骨骨折的疗效

Intramedullary Femoral Neck Cannulated Screw Fixation and Steel Plate for Clavicle Fractures in Adults

目的探讨股骨颈空心螺钉髓内固定与重建钢板治疗成人锁骨骨折的手术方法及临床疗效。方法将80例锁骨骨折患者按随机数字表法分为2组,每组40例。股骨颈空心螺钉组采用股骨颈空心螺钉髓内固定治疗;钢板组采用锁骨解剖型接骨板治疗。对2组患者手术时间、术中出血量、骨折愈合时间、并发症及术后1年Neer肩关节功能评分情况进行比较。结果 2组患者均完成手术,股骨颈空心螺钉组术中发生骨劈裂1例,临时更改为钢板固定。股骨颈空心螺钉组的手术时间、术中出血量及骨折愈合时间均低于钢板组（P〈0.01或P〈0.05）。2组患者术后均获13~24个月的随访。术后1年行Neer肩关节功能评分,股骨颈空心螺钉组为（95.8±4.2）分;钢板组平均为（94.6±5.4）分,2组比较差异无统计学意义（P〉0.05）。股骨颈空心螺钉组术后2周出现螺钉轻度退钉及骨折端旋转2例,予以继续悬吊制动3~4周后骨折愈合,未发生感染、皮肤坏死、螺钉断裂及骨折不愈合病例。钢板组出现切口麻木3例,术后4周出现钢板断裂1例,予以患肢悬吊固定8周后骨折愈合,未出现感染、皮肤坏死病例。结论股骨颈空心螺钉髓内固定治疗锁骨骨折具有减少手术创伤、骨折愈合相对较快、节约医疗费用及减少并发症发生等优势。

Objective To study the surgical methods and clinical efficacies of intramedullary femoral neck cannulated screw fixation and steel reconstruction plates in the treatment of adult clavicle fractures. Methods Eighty patients with clavicle fractures were randomly treated with either intramedullary femoral neck cannulated screw fixation（intramedullary femoral neck cannulated screw fixation group, n =40） or clavicle anatomical plates（steel plate group, n =40）. The operation time,intraoperatve blood loss, fracture healing time and complications were observed in both groups. In addition, shoulder joint function was evaluated by Neer shoulder joint activity score 1 year after operation. Results All patients completed operation. One patient in intramedullary femoral neck cannulated screw fixation group had bone splitting during operation and was converted to plate fixation.Compared with steel plate group, operation time, intraoperatve blood loss and fracture healing time significantly decreased in intramedullary femoral neck cannulated screw fixation group（P〈0.01 or P〈0.05）. All patients were followed up for 13-24 months. No significant difference in the Neer shoulder joint activity score between intramedullary femoral neck cannulated screw fixation group and steel plate group 1 year after operation（95.8 ±4.2 vs 94.6 ±5.4, P〈0.05）. Mild screw retreat and end rotation occurred in 2 patients in intramedullary femoral neck cannulated screw fixation group（fractures healed after continued suspension for 3-4 weeks）. No infection, skin necrosis, screw fracture and nonunion occurred in intramedullary femoral neck cannulated screw fixation group. In steel plate group, incision numbness occurred in 3, and plate fracture occurred 4 weeks after operation in 1（fractures healed after suspension for 8 weeks）. No infection and skin necrosis occurred in steel plate group. Conclusion Intramedullary femoral neck cannulated screw fixation can reduce surgical trauma, promote fracture healing, lower medical costs and decrease complications in patients with clavicle fractures.