保守治疗和手术治疗老年锁骨中段移位骨折的疗效比较

Comparison of the efficacy of conservative treatment and operative treatment in elderly patients with displaced midshaft clavicular fractures

目的比较保守治疗、切开复位内固定术(open reduction and internal fixation,ORIF)和微创经皮钢板内固定术(minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗老年锁骨中段移位骨折的疗效。方法回顾性分析2011年1月至2016年1月第二军医大学附属长海医院采取保守治疗、ORIF技术以及MIPPO技术治疗的锁骨中段移位骨折患者85例,其中男57例、女28例。保守治疗组30例,ORIF组33例,MIPPO组22例。疗效指标包括骨折不愈合,并发症发生率,臂、肩和手功能障碍(disability of the arm,shoulder and hand,DASH)评分和Constant评分等。结果保守治疗组、ORIF组和MIPPO组的治疗成功率分别为80%、84.8%和90.9%(P=0.723)。与保守治疗组相比,ORIF组以及MIPPO组的骨愈合时间明显缩短,分别为(16.7±2.9)周、(14.5±2.0)周和(13.4±1.8)周,P<0.01;Constant评分升高,分别为(86.3±2.6)分、(90.8±3.2)分和(92.4±2.8)分,P<0.01;DASH评分降低,分别为(11.9±2.7)分、(8.9±1.4)分和(8.5±1.5)分,P<0.01。ORIF组以及MIPPO组患者对疼痛缓解满意率明显高于保守治疗组,分别为90.9%、90.9%和40%,P<0.01。同样,ORIF组以及MIPPO组患者对功能恢复的满意率也明显高于保守治疗组,分别为93.9%、100%和60%(P<0.01)。然而,ORIF组对术后外观的满意率显著低于保守治疗组和MIPPO组,分别为69.7%、100%和90.9%(P=0.039)。结论 MIPPO技术用于治疗老年锁骨中段移位骨折可以提供充分的固定、缓解疼痛和恢复肩功能,是一种理想的治疗方案。

Background The clavicular fractures account for 2.6%-5.0%of adult fractures and the midshaft clavicular fractures are the most common type(80%).Clavicle fractures mainly occur in young male adults,which are displaced because of high-energy trauma.However,epidemiology study has also shown a certain degree of incidence in elderly patients with osteoporosis,and these fractures are usually caused by low-energy trauma.Conventional treatment for clavicular fractures was nonoperative therapy.Nevertheless,accumulating evidences showed that the complications of conservative treatment such as nonunion,malunion,shoulder dysfunction,etc.had a relatively high incidence.In 1997,a retrospective study showed that the conse rvative treatment of displaced clavicular fractures with an initial shortening of≥20 mm was associated with the greater risks of fracture nonunion and poor clinical outcomes.In 2006,the other study had reported that the conservative treatment of displaced midshaft clavicular fractures was liable to cause deficits of shoulder strength and endurance.Currently,the technique of open reduction and internal fixation has been widely adopted for the treatment of displaced midshaft clavicular fractures,which has shown greater advantages compared with conservative treatment.