Nice结联合弹性钉固定治疗成人Robinson 2B型锁骨中段骨折

Effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults

目的探讨Nice结联合弹性钉固定治疗成人Robinson 2B型锁骨中段骨折的疗效。方法 2016年3月-2018年1月,采用Nice结联合弹性钉固定治疗20例成人Robinson 2B型锁骨中段骨折患者。男13例,女7例;年龄18~56岁,平均43岁。致伤原因:交通事故伤6例,摔伤12例,高处坠落伤2例。受伤至入院时间1 h^2 d,平均3.2 h。骨折分型:Robinson 2B1型16例,2B2型4例。记录手术切口总长度、手术时间、术后第2天疼痛视觉模拟评分(VAS)、骨折愈合时间,以及相关并发症发生情况。术后1年采用Constant评分及手臂、肩和手残疾(DASH)评分评价患者肩关节功能。记录二次手术取内固定物时手术切口长度及手术时间。结果患者手术切口总长度为2~6 cm,平均4.7 cm;手术时间45~120 min,平均77.2 min。术后第2天VAS评分为1~5分,平均3.2分。术后切口均Ⅰ期愈合,无切口感染、神经损伤并发症发生。20例患者均获随访,随访时间12~32个月,平均18.6个月。影像学复查示骨折均愈合,愈合时间为10~15周,平均12.1周。术后1年,肩关节Constant评分为92~98分,平均96.3分;DASH评分为0~6.4分,平均3.1分。术后1例发生弹性钉弯曲、肥大性骨不连,1例局部皮肤激惹。患者术后12~26个月(平均14.6个月)二次手术取出内固定物,手术切口长度为1~2 cm,平均1.3 cm;手术时间5~15 min,平均9.0 min。结论 Nice结联合弹性钉固定治疗成人Robinson 2B型锁骨中段骨折,手术切口小,术后疼痛轻,骨折愈合快,二次取钉损伤小,同时避免了锁骨上皮神经损伤风险,可获得较好疗效。

Objective To investigate the effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults.Methods Between March 2016 and January 2018,20 patients with Robinson type 2B midshaft clavicular fractures were treated with reduction and internal fixation by Nice knot and elastic intramedullary nailing.There were 13 cases and 7 cases,with an average age of 43 years(range,18-56 years).The causes of injury included the traffic accident in 6 cases,falling in 12 cases,and falling from height in 2 cases.The interval between injury and admission ranged from 1 hour to 2 days(mean,3.2 hours).The fractures were classified as Robinson type 2B1 in 16 cases and type 2B2 in 4 cases.The length of incision,the operation time,the visual analogue scale(VAS)score on the 2nd day after operation,the fracture healing time,the postoperative shoulder function and the Disability of Arm Shoulder and Hand(DASH)score,the complications,and the time of second surgical removal of internal fixator and incision length were recorded.Results The length of incision was 2-6 cm(mean,4.7cm).The operation time was 45-120 minutes(mean,77.2 minutes).The VAS score was 1-5(mean,3.2)on the 2nd day after operation.All incisions healed by first intention and no infection or nerve injury occurred.All patients were followed up 12-32 months(mean,18.6 months).All fractures healed with the healing time of 10-15 weeks(mean,12.1 weeks).The Constant score was 92-98(mean,96.3)and DASH score was 0-6.4(mean,3.1).The elastic intramedullary nailing bending and hypertrophic nonunion occurred in 1 case and the skin stimulated by elastic nail tail in 1 case after operation.The internal fixators were removed at 12-26 months(mean,14.6 months)after operation.And the length of incision was 1-2 cm(mean,1.3 cm)and the operation time was 5-15 minutes(mean,9.0 minutes).Conclusion For the midshaft clavicular fracture in adults,the procedure of the Nice knot combined with elastic intramedullary nail has advantages of small incision,light pain,rapid fracture healing,small secondary operation injury,and avoiding the risk of clavicular epithelial nerve injury,and can obtain good effectiveness.