“移动视窗”半直视技术微创复位与切开复位钛板内固定治疗锁骨中段骨折的疗效比较

Efficacy of minimally invasive reduction by semi-direct visual technique under “mobile window” versus open reduction and internal fixation using titanium plate for treating mid-clavicle fracture: a comparative study

目的评价"移动视窗"半直视技术微创复位与切开复位钛板内固定治疗锁骨中段骨折的疗效。方法选择64例锁骨中段骨折患者为研究对象,按照入院编号奇偶性分为移动视窗组和切开复位组,每组32例。移动视窗组采用"移动视窗"半直视技术微创复位钛板内固定,切开复位组采用切开复位重建锁定钛板内固定。记录并比较两组手术切口长度、术中出血量、手术时间、术后并发症、骨折愈合时间、末次随访时Constant-Murley肩关节功能评分等指标。结果移动视窗组切口长度为(3. 9±0. 4) cm,显著短于切开复位组的(9. 9±1. 2) cm;术中出血量为(43. 6±10. 3) m L,显著少于切开复位组的(51. 8±13. 2) m L;手术时间为(67. 2±8. 8) min,显著长于切开复位组的(60. 6±8. 5) min;骨折愈合时间为(10. 8±1. 1)周,显著短于切开复位组的(12. 6±2. 2)周(均P <0. 05)。两组患者末次随访时Constant-Murley肩关节功能评分比较,差异无统计学意义(P> 0. 05)。末次随访时根据Constant-Murley肩关节功能评分标准评定疗效:移动视窗组优28例,良3例,可1例,优良率为96. 9%;切开复位组优25例,良4例,可3例,优良率为90. 6%。两组疗效比较,差异无统计学意义(P> 0. 05)。结论与切开复位钛板内固定术相比,"移动视窗"半直视技术微创复位钛板内固定治疗锁骨中段骨折微创、美观、愈合快且疗效确切,患者能早期进行功能锻炼、功能恢复快,是一种值得推荐的治疗方法。

Objective To evaluate the efficacy of minimally invasive reduction by semi-direct visial technique under“mobile window”and open reduction and internal fixation using titanium plate for treating mid-clavicle fracture.Methods A total of 64 patients with mid-clavicle fracture were selected as subjects,and were divided into mobile window group and open reduction group according to the parity of admission number,with 32 cases in each group.The mobile window group received minimally invasive reduction using semi-direct visual technique under“mobile window”and internal fixation using titanium plate,while the open reduction group received open reduction and internal fixation using reconstruction and locking titanium plate.The surgical incision length,intraoperative blood loss,operative duration,postoperative complications,duration for fracture healing,the Constant-Murley shoulder function score at the last follow-up were recorded and compared between the two groups.Results Shorter surgical incision[(3.9±0.4)cm vs.(9.9±1.2)cm],less intraoperative blood loss[(43.6±10.3)mL vs.(51.8±13.2)mL],longer operation duration[(67.2±8.8)min vs.(60.6±8.5)min],shorter duration for fracture healing[(10.8±1.1)weeks vs.(12.6±2.2)weeks]were observed in the mobile window group compared with the open reduction group(all P<0.05).There was no statistical difference in the Constant-Murley shoulder function score at the last follow-up between the two groups(P>0.05).According to the standard of Constant-Murley shoulder function score at the last follow-up,the curative effect of the mobile window group were evaluated as excellent,good and fair in 28 cases,3 cases and 1 cases respectively,and the excellent and good rate was 96.9%;the curative effect of the open reduction group were evaluated as excellent,good and fair in 25 cases,4 cases and 3 cases respectively,and the excellent and good rate was 90.6%.There was no statistical difference in curative effect between the two groups(P>0.05).Conclusion Compared with open reduction and internal fixation using titanium plate,minimally invasive reduction by semi-direct visual technology under“moving window”and internal fixation using titanium plate in the treatment of mid-clavicle fracture has the advantages of minimal invasion,satisfactory cosmetic effect,fast healing and definite curative effect.The patients can obtain early functional exercises and fast recovery.It is a recommendable therapy.