经皮微创与传统切开复位锁定钢板内固定治疗成人复杂锁骨中段骨折的疗效比较

Operative treatment of complex fractures of midshaft clavicle using a locking plate： a comparison between mini-invasive plate osteosynthesis（MIPO） and conventional open reduction

目的比较经皮微创（MIPO）与传统切开复位锁定钢板内固定治疗成人复杂锁骨中段骨折的临床疗效。方法回顾性分析2010年1月至2016年2月期间采用MIPO技术或传统切开复位锁定钢板内固定治疗的84例成人复杂锁骨中段骨折患者资料。根据治疗方式不同分为2组：MIPO组41例，采用MIPO技术治疗；切开组43例，采用传统切开复位内固定治疗。比较两组患者的切口总长度、住院时间、骨折愈合时间、术后Constant评分和肩臂手功能障碍评分（DASH）、患者满意度及并发症发生情况等。结果MIPO组与切开组患者术后分别获平均（21．2±9．2）、（23．1±11．8）个月随访。MIPO组患者的切口总长度[（4．3±0．5）cm]较切开组患者[（8．4±1．3）cm]短，住院时间[（7．7±1．9）d]及骨折愈合时间[（10．6±3．2）周]较切开组患者[（9．6±3．1）d、（12．3±3．9）周]短，差异均有统计学意义（P〈0．05）。MIPO组患者术后肥厚性瘢痕、局部皮肤感觉障碍发生率较切开组患者低，但患者总体疗效满意度较切开组患者高，差异均有统计学意义（P〈0．05）。而两组患者术后3、6个月及末次随访时Constant评分及DASH评分比较差异均无统计学意义（P〉0．05）。结论与传统切开复位内固定术相比，MIPO技术治疗成人复杂锁骨中段骨折具有切口小而美观、骨折愈合时间及住院时间短等优势。两种术式均能取得良好的临床功能结果，但是MIPO组患者满意度更高。

Objective To compare the clinical outcomes of mini-invasive plate osteosynthesis （MIPO） and conventional open plating for complex fractures of midshaft clavicle. Methods The authors retrospectively reviewed the data of complex fractures of midshaft clavicle （AO/OTA types 15-B2 and 15-B3） which had been treated with MIPO or conventional open plating between January 2010 to February 2016. Forty-one patients were treated with MIPO and 43 with conventional open plating. The 2 groups were compared in terms of incision length, hospital stay, bone union time, postoperative Constant score and Disabilities of the Arm, Shoulder and Hand （DASH） score, patients＇ satisfaction and complications. Results The average follow-up was 21.2 ± 9.2 months for MIPO group and 23.1 ± 11.8 months for conventional open plating group. The incision length （4. 3 ±0. 5 cm）, hospital stay （7.7 ± 1.9 d） and union time （10. 6 ±3.2 w） in the MIPO group were significantly shorter than those in the conventional open plating group （8.4 ± 1.3 cm, 9.6 ±3.1 d and 12.3 ± 3.9 w, respectively） （P 〈 0.05）. The MIPO group had significantly lower incidences of hypertrophic scarring and dysesthesia in the area of incision but significantly higher patients＇ satisfaction than the conventional open plating group （ P 〈 0. 05）. There were no significant differences in the Constant score or DASH score at 3 months, 6 months and the final follow-up （ P 〉 0. 05）. Conclusion In the treatment of complex fractures of midshaft clavicle, although both MIPO and conventional open plating can lead to similar functional outcomes, MIPO may be advantageous over conventional open plating in smaller surgical incision, more rapid fracture union, shorter hospital stay and higher patients＇ satisfaction.