Nice结联合锁定接骨板治疗严重锁骨中段骨折

Operative treatment of severe midshaft clavicluar fracture using nice knot with locking compression plate(LCP)

目的:探讨应用Nice结联锁定接骨板治疗严重锁骨中段骨折的临床疗效.方法:回顾性分析2015年5月-2016年12月应用Nice结联合锁定接骨板治疗36例严重锁骨中段骨折,男24例,女12例,年龄18-75岁,平均44.5岁,按Robinson分型ⅡB1型10例,ⅡB2型26例.所有患者均手术切开复位,Nice结捆扎主要骨折块后锁定接骨板置于锁骨上方固定,术后每隔2周复查X线片至骨折愈合,骨折愈合后每隔3个月复查X线片.采用Constant-Murley评分标准进行肩关节功能评价,并根据患者有无畸形、感觉异常及疤痕情况进行主观满意度评价,同时记录骨折愈合时间和术后并发症情况.结果:所有患者获得12-26个月(平均18个月)的随访,术后8-12周(平均10.5周)骨折全部愈合,无感染、骨不连及钢板断裂.本组手术时间为40-70分钟(平均50.6分钟),术中出血量20-60ml(平均40.5ml),术中透视时间6-12秒(平均8.5秒),术后住院时间5-9天(平均7天).8例术后18-24个月取出内固定,取出内固定后无再骨折发生.末次随访时,肩关节功能采用Constant-Murley评分为88-98分(平均94.5分).患者主观满意率为91.7%(33/36),3例不满意原因为术区局部皮肤感觉异常,但均在术后2个月内完全恢复.结论:采用Nice结联合锁定接骨板治疗严重锁骨中段骨折优势明显,并发症发生率低,且取出内固定更简便更安全,是一种理想的手术方法.

Objective:To investigate the clinical outcomes of Nice Knot with Locking Compression Plate(LCP)in the Operative Treatment of Severe Midshaft Clavicluar Fracture.Methods:Between May 2015 to December 2016,the clinical data of 36 cases of severe mid-clavicular fractures which had been treated with Nice Knot with LCP fixation were retrospectively reviewed.There were 24 males patients and 12 females patients with a mean age of 44.5 years.10 cases were II B1 type and 26 cases were II B2 type by Robinson classification.The major fracture was fixed by LCP on the superior side of clavical and the fragments were tied by Nice Knot.After surgery,X-rays were performed every 2 weeks until bony union and then every 3 months postoperative.The function of shoulder joint was evaluated by constant-murley score,and subjective satisfaction was evaluated according to whether the patient had malformation,paresthesia and scar condition.The time of bony nuion and postoperative complications were recorded.Results:All patients were followed up for 12 to 26 months(mean 18 months),and all patients obtained bony union.The union time was 8 to 12 weeks,with a mean time of 10.5 weeks.No infec-tion,no nonuoin or plate fracture were observed.The operative time was 40〜70min(mean 50.6min),intraoperative blood loss was 20〜60ml(mean 40.5ml),intraoperative fluoroscopy was 6〜12s(mean 8.5s),and postoperative hospital stay was 5〜9d(mean 7d),Inter-nal fixations were taken out in 8 cases 18 to 24 months after surgery,and no further fracture occurred after the removal of internal fixation.At the last follow-up,the constant-murley score for shoulder function was 88-98(mean 94.5).The subjective satisfaction rate of the patients was 91.7%(33/36).The reason for dissatisfaction in the 3 cases was local skin paresthesia in the operative area,but they all recovered completely within 2 months after surgery.Conclusion:Nice Knot with LCP was an ideal surgical method for the treatment of severe mid-clavicular fractures with obvious advantages,low incidence of complications,and more convenient and safer removal of internal fixations.