锁骨干骨折微创髓内固定治疗进展

Treatment progress in minimally invasive intramedullary fixation for midshaft clavicle fracture

近年来,微创治疗锁骨骨折技术被越来越多地报道。本文基于近年来有关锁骨干骨折微创髓内固定的研究,介绍了锁骨干骨折髓内固定的适应证和优势,系统性详述各种锁骨髓内固定产品的设计特点、手术方式、固定效果以及最新治疗进展。在适应证方面,除陈旧性骨折、合并神经、血管伤以及节段性粉碎的锁骨干骨折外均可采用髓内固定。固定物主要有克氏针、空心钉、钛制弹性钉、螺纹髓内钉以及第二代髓内固定产品。髓内固定具有切口小、相关并发症少、再骨折风险低及愈合快等优势,但同时存在固定强度和稳定性的问题。从空心钉到第二代髓内固定产品的髓内固定器械越来越多地应用于临床并取得了良好的效果,目前仍有新产品不断研发中以改进先前缺陷。

Nowadays,more and more studies on mini-invasive treatment of clavicle fractures have been reported.Firstly,based on the newly published literature about intramedullary fixation for midshaft clavicle fractures,this paper reviews its indications and advantages.Next,the design characteristics,surgical procedures,therapeutic effects and latest treatment advances concerning the intramedullary implants are systemically demonstrated and compared.Intramedullary fixation can be used in most midshaft clavicle fractures except those with neurovascular lesions or with comminuted segments,or obsolete ones.The commonly used intramedullary implants include Kirschner wires,cannulated screws,titanium elastic nails,threaded nails,and second-generation intramedullary nails.Intramedullary fixation has potential advantages of a smaller incision,fewer complications,a lower refracture risk and faster bone healing but also limitations in strength and stability.However,more and more intramedullary implants,from cannulated screws to second-generation intramedullary nails,have been used in clinic,leading to fine therapeutic effects.New products are being developed to overcome the previous shortcomings.