锁骨内固定术后再骨折二次手术的临床观察

Clinical observation of the second operation for refracture after internal fixation of clavicle

目的:探讨二次手术内固定在锁骨骨折术后再骨折中的临床效果。方法:自2010年3月至2016年3月9例锁骨骨折术后再骨折(骨折愈合前钢板断裂以及钢板、螺钉拔出或者骨折愈合后取内固定后再骨折)患者,男6例,女3例;年龄20~62岁,平均38.6岁。外伤类型:运动损伤3例,交通伤5例,重物打伤1例。均为闭合性骨折,其中多发骨折2例。术前病程2~9 d,平均2.7 d。根据OTA(Orthopaedic Trauma Association classification)分型,包含2例06-A1,1例06-A2,1例06-A3,2例06-B1,2例06-B2,1例06-B3。其中近期4例采用AO钛制弹性髓内钉(TEN)手术治疗,早期的5例锁骨骨折术后内固定失败患者钢板螺钉内固定+植骨术。观察记录其骨折愈合时间、疼痛评分、肩关节功能评分。结果:术后所有患者切口Ⅰ期愈合,无感染情况发生。9例患者获随访,时间14个月,无失访。术后12个月内固定取出,无再骨折病例。肩关节功能Constant评分二次术后4周时64~94分;内固定取出后4周为91~100分。骨折愈合时间为3~6个月,平均4.3个月。患者疼痛VAS评分明显降低,疼痛均明显缓解。结论:钛弹性髓内钉(TEN)治疗锁骨内固定术后二次骨折患者可获得较好的临床效果,创伤小,骨折愈合良好,术后肩关节功能恢复好,但是需要注意合理选择患者。

Objective：To evaluate the outcome of Titanium Elastic intramedullary nailing（TEN） for the treatment of refracture of clavicle. Methods：From March 2010 to March 2016,9 cases of clavicle fracture,postoperative re fracture（plate broken before fracture healing,plate and screw pull out or refracture after fracture union and internal fixation removal） included 6 males and 3 females with a mean age of 38.6 years old ranging from 20 to 62 years old; 3 cases were sports injury,5 cases were traffic injury,1 case was severe injury. All cases were closed fractures,and 2 cases were multiple fractures. According to OTA（Orthopaedic Trauma Association classification）,2 cases were 06-A1,1 case was 06-A2,1 case was 06-A3,2 cases were 06-B1,2 cases were 06-B2,and 1 case was 06-B3. Among them,4 cases were treated with AO titanium elastic intramedullary nail（TEN）,and 5 cases of early internal fixation failure of clavicle fracture were treated with plate and screw internal fixation plus bone graft. The time of bone union,VAS score and Constant Shoulder Score were observed and recorded.Results：All incisions healed at stage Ⅰ without infection. All 9 patients were followed up for a period of 14 months. All patients＇ implants were removed at 12 months after the second operation without refractures. The Constant score of shoulder joint was from 64 to 94 at 4 weeks after the second operation,91 to 100 at 4 weeks after implants removal. The average bone healing time was 4.3 months from 3 to 6 months. The pain VAS score decreased significantly and the pain was relieved significantly.Conclusion：Titanium elastic intramedullary nail（TEN） for the treatment of clavicle fracture after internal fixation of refracture patients can be achieved better outcomes,less trauma,good fracture healing,good postoperative recovery of shoulder joint function,but need to pay attention to the reasonable selection of patients.