4种内固定方法治疗锁骨中段骨折疗效比较

Effect comparison of four kinds of internal fixation methods for treatment of mid-clavicular fracture

目的比较不同内固定方法治疗锁骨中段骨折的疗效。方法应用重建锁定钢板、锁定解剖钢板、Herbert中空螺钉和交锁髓内钉4种内固定方法治疗111例锁骨中段骨折患者。比较4种手术方法的手术时间、切口长度、术中出血量、骨折愈合时间及肩关节功能。结果患者均获得随访,时间12~18个月。手术时间：重建锁定钢板组长于锁定解剖钢板组、Herbert中空螺钉组和交锁髓内钉组,差异有统计学意义（P〈0.05）。术中出血量：重建锁定钢板组和锁定解剖钢板组多于Herbert中空螺钉组和交锁髓内钉组,差异有统计学意义（P〈0.05）。切口长度：重建锁定钢板组和锁定解剖钢板组长于Herbert中空螺钉组和交锁髓内钉组,差异有统计学意义（P〈0.05）。骨折愈合时间：重建锁定钢板长于锁定解剖钢板组、Herbert中空螺钉组和交锁髓内钉组,差异有统计学意义（P〈0.05）。4种手术方法肩关节功能JOA评分比较差异无统计学意义（P〉0.05）。并发症：重建锁定钢板组、锁定解剖钢板组各有2例钢板断裂,Herbert中空螺钉组2例退钉,交锁髓内钉组无并发症发生。结论 4种固定方法治疗锁骨中段骨折均取得满意疗效,Herbert中空螺钉和交锁髓内钉固定治疗锁骨中段骨折较重建锁定钢板和锁定解剖钢板固定更符合生物力学特性,更具合理性。

Objective To compare the curative effect of mid-clavicular fracture treated by different methods. Methods Data of 111 cases treated by reconstruction locking plate,locking anatomic plate,Herbert hollow screw and interlocking intramedullary nails were chosen. The differences of four kinds of surgical methods in operation time,incision length,intraoperative blood loss,fracture healing time and shoulder joint function for JOA scores were compared. Results All patients were received 12 ~ 18 months follow-up. Operation time： reconstruction locking plate group was longer than locking anatomic plate group,Herbert hollow screw and interlocking intramedullary nailing group,the difference was statistically significant（ P 〈 0. 05）. Intraoperative blood loss： reconstruction locking plate group and locking anatomic plate group were more than Herbert hollow screw and interlocking intramedullary nailing group,the difference was statistically significant（ P 〈 0. 05）. Incision length： reconstruction locking plate group and locking anatomic plate group were longer than Herbert hollow screw and interlocking intramedullary nail group,the difference was statistically significant（ P 〈 0. 05）. Fracture healing time： reconstruction locking plate was longer than locking anatomic plate group,Herbert hollow screw and interlocking intramedullary nailing group,the difference was statistically significant（ P 〈 0. 05）. In the aspect of shoulder joint function（ JOA score）,there was no statistically significant difference by comparing the four kinds of operation method（ P 〉 0. 05）. Complications： there were 2 cases of plate breakage in reconstruction locking plate group and locking anatomical plate group respectively,2 cases of screw exit in Herbert hollow screw group,and interlocking intramedullary nail group had no complications occurred. Conclusions All four kinds of mid-clavicular fracture fixation method has achieved satisfied curative effect. It conform to the biomechanical characteristics and rationality that Herbert hollow screw and interlocking intramedullary nail are better than reconstruction locking plate and locking anatomic plate for treatment of mid-clavicular fracture.