锁骨钩钢板和克氏针张力带治疗锁骨远端骨折的效果比较

Comparison of Effect of Clavicular Hook Plate and Kirschner Wire Tension Band in Treatment of Distal Collarbone Fracture

目的比较锁骨钩钢板和克氏针张力带治疗锁骨远端骨折的治疗效果。方法回顾性分析2015年8月至2017年10月山西医科大学第一医院确诊为NeerⅡ型锁骨远端骨折且无手术禁忌的30例成年患者的临床资料,依据治疗方法不同分为锁骨钩钢板组(18例)和克氏针张力带组(12例)。随访观察两组术后皮肤切口愈合情况、骨折愈合及内固定位置,评估患者手术前后Constant肩关节评分和疼痛视觉模拟评分(VAS)。结果所有患者皮肤切口均甲级愈合,未出现感染。锁骨钩钢板组平均愈合时间短于克氏针张力带组[(8.98±0.32)周比(8.74±0.21)周](P<0.05)。Constant肩关节评分的组间和时点间存在交互作用(P<0.01),两组手术前后Constant肩关节评分的变化幅度不同(P<0.01)。VAS评分的组间和时点间存在交互作用(P<0.01),两组手术前后VAS评分变化幅度不同。克氏针张力带组未发生任何不良反应,锁骨钩钢板组1例患者发生肩峰下溶解。结论锁骨钩钢板和克氏针张力带均为手术治疗锁骨远端骨折的有效方式,锁骨钩钢板效果更佳,克氏针张力带更适合基层医院及经济困难的患者。

Objective To compare the therapeutic effect of clavicular hook plate and Kirschner wire tension band in the treatment of distal clavicle fracture.Methods The clinical data of 30 adult patients with Neer typeⅡdistal clavicle fracture(without surgery contraindication)diagnosed in the First Hospital of Shanxi Medical University from Aug.2015 to Oct.2017 were retrospectively analyzed,and they were divided into a clavicular hook plate group(18 cases)and a Kirschner wire tension band group(12 cases)according to different treatment methods.The skin incision healing,fracture healing and internal fixation position of the two groups were observed.The Constant shoulder score and visual analogue scale(VAS)were evaluated before and after operation.Results All the skin incisions healed in Grade A without infection.The average healing time of clavicular hook plate group was shorter than that of the Kirschner wire tension band group[(8.98±0.32)weeks vs(8.74±0.21)weeks](P<0.05).There was interaction in Constant shoulder joint score between groups and time points(P<0.01),and the changing ranges of Constant shoulder joint score before and after operation of the two groups were different(P<0.01).There was interaction in VAS score between groups and time points(P<0.01),and the changing ranges of VAS scores before and after operation of the two groups were different.There was no adverse reaction in the Kirschner wire tension band group,and one patient in the clavicular hook plate group had subacromial dissolution.Conclusion Clavicular hook plate and Kirschner wire tension band are both effective methods for the treatment of distal clavicle fracture.Hook plate group has better effect,and Kirschner wire tension band is more suitable for primary hospitals and patients with financial difficulties.