弹性髓内针治疗锁骨中段移位骨折的疗效评价

Effect evaluation of ESIN for midclavicular displacement fractures

目的 评估弹性髓内针（Elastic Stable Intramedullar Nail,ESIN）治疗锁骨中段明显短缩移位骨折的治疗效果。方法 对2009年4月-2012年4月期间23例锁骨中段明显短缩移位骨折的患者进行回顾性分析。手术均采用锁骨内侧端切口进针,除3例直接闭合复位或克氏针辅助下闭合复位成功外,其余患者均在骨折处小切口切开复位。术后进行影像学检查随访,门诊完成Constant-Murley肩关节功能评分和患者满意度调查。结果 所有患者完成门诊随访,平均随访时间（20.1±0.3）个月,Constant-Murley肩关节功能最终评分平均（97.8±1.1）分。所有患者内固定均取出：1例患者术后6个月骨折愈合后ESIN远端穿破锁骨远端后方皮质造成局部软组织疼痛,提前手术取出,余患者均在术后12-18个月骨折愈合后取出。所有患者影像学检查提示骨性愈合,平均愈合时间（13.2±0.3）周,无畸形愈合和延迟愈合。骨折愈合后锁骨短缩3例,均见于C型粉碎骨折。锁骨内侧针尾皮肤激惹征5例,ESIN取出后愈合。结论 ESIN治疗锁骨中段明显短缩移位骨折并发症少,操作简单,锁骨长度恢复满意,外观和功能良好,能快速恢复日常活动。

Objective To evaluate therapeutic effect of elastic stable intramedullar hail（ESIN） applied in the seriously displaced and shortened midshaft clavicle fractures.Methods A total of 23 cases of seriously displaced and shortened midshaft clavicle fractures were analyzed retrospectively from April 2009 to April 2012.Operation incision into the needle were in the medial end of the clavicle,3 cases with closed reduction directly or assisted closed reduction with K-wire,other patients with open reduction by a small incision in the place of fracture.Postoperative imaging examination,the Constant-Murley score of shoulder function and patient satisfaction survey were performed in outpatient.Results All the patients completed the follow-up and the mean follow-up time was（20.1 ±0.30） months.Constant-Murley shoulder functional score was（97.8±l.l） points.All patients were taking out internal fixation,1 case with ESIN removed in advance in 6 months postoperative for local soft tissue pain caused by nail＇s puncture of distal clavicle posterior cortex while fracture had healed,other patients were removed in 12-18 months postoperative after fracture healing.All patients＇ imaging revealed fracture healing with the average healing time of（13.2±0.3） weeks,no deformity union and delayed union.Clavicular shortening were found in 3 cases comminuted fracture after fracture healing.Medial clavicle skin irritation sign by nail tail occoured in 5 cases,healed after removing of ESIN.Conclusion The treatment of seriously displaced and shortened midshaft clavicle fracture with ESIN has the advantages of simple operation,less complications,the length of clavicle recovered satisfactorily,appearance and good function,quickly returning to daily activities.