两种内固定治疗锁骨远端粉碎性骨折的疗效比较

Comparison effect of two internal fixation methods for distal clavicle comminuted fractures

目的比较两种内固定治疗锁骨远端粉碎性骨折的临床疗效。方法 将48例锁骨远端粉碎性骨折患者按内固定方式不同分为锁骨钩钢板组(22例)和微型双钢板组(26例)。比较两组手术时间、术中出血量、住院费用、骨折愈合时间、肩关节运动范围及术后并发症发生情况。采用Constant-Murley评分评价肩关节功能。结果 48例患者均获得随访,时间12~17个月。手术时间和术中出血量两组比较差异均无统计学意义(P>0.05)。住院费用和骨折愈合时间微型双钢板组少于锁骨钩钢板组(P<0.001)。Constant-Murley评分:术后2个月微型双钢板组优于锁骨钩钢板组(P<0.001);术后6个月、内固定取出前1周及末次随访时两组比较差异均无统计学意义(P>0.05)。术后并发症发生率锁骨钩钢板组高于微型双钢板组(P<0.05)。结论 两种内固定治疗锁骨远端粉碎性骨折均可获得较好的临床效果,但微型双钢板垂直内固定住院费用较少,骨折愈合时间更短,术后并发症少,更具优势。

Objective To compare the effect of two internal fixations in the treatment of distal clavicle comminuted fractures. Methods The 48 patients with distal clavicle comminuted fractures were received surgical treatment. They were divided into the clavicular hook plates group(22 patients) and double mini-plates group(26 patients).A retrospective study was performed to compare the outcomes of the two methods regarding the operation time,intraoperative bleeding volume,hospitalization expense,fracture healing time,mobility of shoulder joint and complications. The functional recovery of the shoulder joint was assessed by using Constant-Murley shoulder scoring system. Results The patients were followed up for 12~17 months.The differences in operation time and intraoperative bleeding volume were not statistically significant between the two groups( P >0.05).In hospitalization expense and fracture healing time,the double mini-plates group were less than the clavicular hook plates group( P < 0.001).At 2-month of follow-up, the Constant-Murley shoulder score in the double mini-plates group was significantly better than the clavicular hook plates group ( P <0.001);but at 6-month follow-up, 1-week before removal of internal fixation and the final follow-up,two groups had no significant differences( P >0.05).The incidence rate of complication in the clavicular hook plates group were higher than that of the double mini-plates group ( P <0.05). Conclusions Two internal fixation techniques can attain good clinical outcomes in treatment of distal clavicle comminuted fractures. The double mini-plates fixation has advantages of lower hospitalization expense, faster fracture healing, reduction of complications, which is a more effective method to treat distal clavicle fractures for the patients.