标准化手术步骤在锁骨中段骨折术中的应用

Effects of standardization for operation step in treatment of middle clavicle fractures

目的探讨标准化手术步骤在锁骨中段骨折内固定术中的应用价值。方法共纳入自2010—01—2014—01诊治并符合标准的82例锁骨中段骨折，42例内固定术中采用标准化手术步骤（标准组），40例由手术医师根据经验自行决定手术步骤（对照组）。比较2组手术时间、术中出血量及并发症情况。结果标准组手术时间（35．30±18．14）rain，术中出血量（30．50±16．24）ml：对照组手术时间（68．55±17．54）rain，术中出血量（88．22±12．48）ml；标准组手术时间（t=2．09，P=0．03）、术中出血量（t=1．98，P=0．01）均明显少于对照组，差异有统计学意义（P〈0．05）。术后82例均获得12个月以上随访，骨折均在术后3～6个月完全愈合。标准组切口均一期愈合。对照组1例切口感染，经过2个月换药后愈合；1例锁骨下静脉损伤，术中给予修补后预后良好；1例2个月后复查钢板拔出，二次手术后骨折愈合。结论采用标准化手术步骤治疗锁骨中段骨折可以显著减少手术时间及术中出血量，降低了并发症的发生率，提高手术效率。

Objective To investigate the effects of standardization for operation step in treatment of middle clavicle fractures. Methods From January 2010 to January 2014, 82 cases of middle clavicle fractures were treated with open reduction anatomy plate fixation by same approach and same company implant. The patients were divided into two groups randomly, standardization group of 42 cases with the standardization operation step and control group of 40 cases with the different operation step according to the surgeon＇s experience. The blood loss, operating time was compared to evaluate the effectiveness. The operation complication was recorded in 12 months follow-up. Results The operation time of standardization group （35.30±18.14）min was shorter than that of the control group （68.55±17.54）min, there was significant difference （P 〈0.05）. The blood loss of the standardization group （30.50±16.24）ml was less than that of the control group （88.22±12.48）ml, there was significant difference （P 〈0.05）. Standardization group had no operation complication, but control group had 1 case of vascular injury, 1 case of skin infection, 1 case of fixation failure. Conclusion Standardization in operation step for treatment of middle clavicle fractures can effectively reduce the operation time, complication and bleeding volume, and improve operation efficiency.