Nice结辅助复位技术与传统复位技术在移位粉碎性锁骨中段骨折中的应用比较

Comparison of the Nice knot assisted reduction technique and the traditional reduction technique in the treatment of displaced comminuted midshaft clavicle fracture

目的比较Nice结辅助复位技术(Nice结固定蝶形骨块)与传统复位技术(螺钉固定蝶形骨块)在成人移位粉碎性锁骨中段骨折(AO分型15-B2型)中的应用,为临床围手术期的处理提供参考。方法回顾性分析2017年1月至2019年6月本科收治且获得完整随访的47例成人锁骨中段粉碎性骨折(AO分型15-B2型)患者资料,其中Nice结辅助复位技术组22例,传统复位技术组25例。分析比较两组手术时间、术中出血量、术后第2天视觉模拟评分(visual analogue scale,VAS)、骨折愈合时间、术后内固定并发症和末次随访肩关节Neer评分。内固定并发症包括:感染、内固定松动、断裂和骨块移位。结果 47例患者术后获6~15个月随访,平均(10.7±3.5)个月。Nice结辅助复位技术组手术时间50~80 min,平均(66.45±7.24) min;术中出血量18~40 ml,平均(29.73±5.63) ml;术后第2天VAS评分1~5分,平均(2.95±1.21)分;骨折愈合时间11~18周,平均(13.91±1.74)周;末次随访肩关节Neer评分90~100分,平均(94.55±3.00)分。传统复位技术组手术时间55~91 min,平均(73.24±10.97) min;术中出血量20~50 ml,平均(35.44±8.52) ml;术后第2天VAS评分1~6分,平均(2.88±1.36)分;骨折愈合时间12~18周,平均(14.08±1.78)周;末次随访肩关节Neer评分90~100分,平均(94.28±2.75)分。两组相比,Nice结辅助复位技术组手术时间短、术中出血量少(P <0.05),而在其他评价指标,两组之间差异均无统计学意义(P> 0.05)。两组患者术口均一期愈合,无内固定松动或断裂并发症发生,无骨折块移位。结论 Nice结辅助复位技术在移位粉碎性锁骨中段骨折中应用,缩短了手术时间,减少术中出血量,术后结果满意,但还需要进一步多中心、前瞻性临床随机对照研究来证实、推广。

Background Clavicular fractures are one of the most common injuries in adults,accounting for 2%to 5%of all fractures,and the incidence is twice as high in young men as in women,possibly because they are at significant risk of trauma.Treatment of clavicular fractures should be guided by the fracture location(middle 1/3,lateral or medial)and the fracture morphology(undisplaced,displaced or comminuted).Current guidelines recommend surgical treatment for clavicular fractures of fully displaced,2 cm of shortened or comminuted in the middle 1/3 third,as these may help to restore shoulder motion earlier and improve eventual shoulder function.In 2019,Guerra,et al.conducted a meta-analysis including 14 randomized controlled trials and 1546 patients.They found that compared with nonoperative treatment,surgical treatment could remarkably reduce the rate of nonunion and shorten the fracture healing time for displaced mid-shaft clavicular fractures.Although the incidence of complications such as infection,nerve injury,etc.were slightly higher,the shoulder function scored higher in the short term and long term follow-ups.Objective To compare the application of Nice knot assisted reduction(Nice knot fixed sphenoid fragment)and traditional reduction(screw fixed sphenoid fragment)in the treatment of adult displaced comminuted mid-shaft clavicular fracture(AO type 15-B2),so as to provide reference for perioperative management in clinical practice.Methods From January 2017 to June 2019,a total of 47 cases with mid-shaft clavicular fractures(AO type 15-B2)were treated in our department with complete follow-ups,and the data were retrospectively analyzed.There were 22 cases in the Nice knot assisted reduction technique group,and 25 cases in the traditional reduction technique group.The operation duration,blood loss,VAS on the postoperative 2nd day,fracture healing time,postoperative complications and Neer scores of shoulder joint were analyzed and compared between two groups.The internal fixator complications included infection,internal fixator loosening,breakage and fragment displacement.Results Forty-seven patients were followed up for 6-15 months after surgery,with an average time of(10.7±3.5)months.In the Nice knot assisted reduction technique group,the operation time was 50-80 min with an average time of(66.45±7.24)min,the intraoperative blood loss was 18-40 ml,(29.73±5.63)ml,the VAS score was 1-5(2.95±1.21)points on the second day after surgery,the fracture healing time was 11-18 weeks with an average of(13.91±1.74)weeks,and the Neer score of shoulder joint was 90-100(94.55±3.00)points in the last follow-up.In the traditional reduction technique group,the operative time of the was 55-91 min with an average of(73.24±10.97)min,and the intraoperative blood loss was 20-50 ml with an average of(35.44±8.52)ml,the VAS score was 1-6(2.88±1.36)points on the second day after surgery,the fracture healing time was 12-18 weeks with an average time of(14.08±1.78)weeks,and the Neer score of shoulder joint was 90-100(94.28±2.75)points in the last follow-up.By comparison,the Nice knot assisted reduction group had shorter operation time and less intraoperative blood loss than those in the traditional reduction group(P<0.05),while there were no statistically significant differences between the two groups in other evaluative indicators(P>0.05).All the fractures in the two groups healed at the first stage.No internal fixator loosening,breakage or fragment displacement occurred.Conclusions The application of Nice knot assisted reduction in the treatment of displaced comminuted mid-shaft clavicular fractures shortened the operation time and reduced the intraoperative blood loss.The postoperative results were satisfactory.However,further multicenter,prospective,randomized controlled clinical studies are required to confirm and promote this technique.