斜行小切口和传统横行切口治疗锁骨中段骨折的疗效比较

Conventional incision versus oblique mini-incision for midshaft clavicular fractures

目的比较斜行小切口和传统横行切口治疗锁骨中段骨折的临床疗效。方法前瞻性的将2014年8月至2016年8月纳入符合标准的79例锁骨中段骨折患者按照随机数字表法分为斜行切口组与横行切口组进行对照研究。斜行切口组37例，男20例，女17例；平均年龄（37．4±13．2）岁；骨折R0binson分型：2A2型9例，281型16例，282型12例。横行切15组42例，男22例，女20例；平均年龄（38．2±14．5）岁；骨折Robinson分型：2A2型9例，281型19例，282型14例。记录并比较两组患者手术时间、术中出血量、手术瘢痕长度、骨折愈合时间、术后1年上肢臂、肩、手功能障碍（DASH）评分、Constant．Murlev评分、并发症发生率以及术后1年患者主观满意度问卷调查情况。结果共有58例患者术后获13～24个月（平均15．3个月）随访，其中斜行切口组28例，横行切15组30例。两组患者术前一般资料比较差异均无统计学意义（P〉0．05），具有可比性。两组患者的手术时间、骨折愈合时间、术后1年患肢DSAH评分、Constant．Murley评分、并发症发生率比较差异均无统计学意义（P〉0．05）；斜行切口组患者术中出血量[（20．8±10．7）mL]少于横行切口组[（41．6±7．6）mL]，手术瘢痕长度[（3．6±1．6）cm]小于横行切15组[（10．3±2．6）cm]，术后1年残留锁骨上神经损伤症状的比率f10．7％（3／28）]低于横行切15组[43．3％（13／30）]，术后1年肩部或胸前区麻木情况、对瘢痕外观满意度和对手术感觉满意情况均优于横行切口组，差异均有统计学意义（P〈0．05）。结论斜行小切15较传统横行切口有出血少、瘢痕小、医源性锁骨上神经损伤小、患者满意度高等优点，两种治疗方式对肩关节功能恢复疗效相当。

Objective To compare the clinical effects of conventional incision versus oblique mini- incision in the treatment of displaced midshaft clavicular fractures. Methods A prospective randomized controlled trial was performed between August 2014 and August 2016 in 79 patients with acute displaced midshaft clavicular fracture. They were randomly divided into 2 groups to receive either conventional incision or oblique mini-incision treatment. In the oblique mini-incision group, there were 37 cases, 20 males and 17 females, with an average age of 37.4 ± 13.2 years. By the Robinson fracture classification, there were 9 cases of type 2A2, 16 ones of type 2B1, and 12 ones of type 2B2. In the conventional incision group, there were 42 cases, 22 males and 20 females, with an average age of 38.2 ~ 14.5 years. By the Robinson fracture classification, there were 9 cases of type 2A2, 19 ones of type 2B1, and 14 ones of type 2B2. We recorded operation time, intraoperative blood loss, scar size, clinical complications and fracture healing time. Functional assessments were conducted at 12 months using the Disabilities of the Arm, Shoulder and Hand （DASH） and Constant-Murley scores, and a questionnaire on numbness, scar appearance and satis- faction. Results Only 58 patients finished a complete follow-up. The preoperative general data showed no statistical significance between the 2 groups （ P 〉 0. 05）. All the 58 patients were followed up for 13 to 24 months （average, 15.3 months）. There were no significant differences between the 2 groups in operation time, fracture healing time, the DASH or Constant-Murley score, or clinical complications （P 〉 0.05）. However, the intraoperative blood loss in the oblique mini-incision group （20. 8 ± 10. 7 mL） was significantly less than that in the conventional incision group （41.6 ±7.6 mL）, the scar size in the former （3.6 ± 1.6 cm） significantly shorter than that in the latter （10.3±2.6 cm）, and the rate of symptoms of residual injury to the supra- clavicular nerve in the former （10.7%, 3/28） significantly lower than that in the latter （43.3%, 13/30） （ P 〈 O. 05 ）. Moreover, the oblique mini-incision group was significantly better than the conventional incision group in numbness on the shoulder or anterior chest, scar appearance and satisfaction. Conclusions The oblique mini-incision may be advantageous over the conventional incision in intraoperative blood loss, scar size and appearance, iatrogenic supraclavicular nerve damage and satisfaction. However, the 2 incisions may lead to similar functional recovery of the shoulder.