Nice结辅助髓内钉与传统切口钢板治疗成人锁骨中段骨折的疗效对比

Comparison of clinical efficacy of Nice knot assisted intramedullary nailing and plate fixation in the treatment of adult midshaft clavicle fracture

目的比较Nice结辅助髓内钉和传统切口钢板治疗成人锁骨中段骨折的临床疗效。方法我科自2016年3月至2018年1月收治成人锁骨中段骨折患者82例,根据治疗方式不同分为2组:髓内钉组26例,Robinson骨折分型:2A型6例,2Bl型16例,2B2型4例;传统切口钢板组56例,Robinson骨折分型:2A型10例,2B1型26例,2B2型20例。记录两组患者初次手术切口长度(髓内钉组为两处切口总长度)、初次手术时间,术后第2天视觉模拟评分(visual analogue scale,VAS)、骨折愈合时间、术后肩关节功能Constant评分及DASH评分,并发症、二次手术取出内固定切口长度及手术时间。结果髓内钉组及传统切口钢板组分别获(19.6±6.1),(21.8±7.6)个月随访,两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。两组患者术后第2天VAS评分、术后肩关节Constant评分及DASH评分,并发症发生率比较差异均无统计学意义(P>0.05)。髓内钉组手术切口长度(4.6±1.2)cm,手术时间(60.3±23.9)min均较传统切口组(11.5±2.2)cm,(79.1±26.9)min短,差异具有统计学意义(P<0.05),髓内钉组骨折愈合时间(12.0±1.3)周较传统切口组(14.0±1.8)周短,髓内钉组二次取出内固定手术切口长度(1.5±0.4)em,手术时间(12.0±5.0)min均较传统切口组(11.1±2.1)cm,(33.2±7.2)min短,差异具有统计学意义(P<0.05)。结论Nice结辅助髓内钉治疗成人锁骨中段骨折可获得与传统切口钢板相当的术后疗效,但手术瘢痕明显小,软组织损伤轻,同时可避免二次手术神经损伤风险。

Objective To compare the clinical efficacy of Nice knot assisted intramedullary nailing and traditional incision plate fixation in the treatment of adult midshaft clavicle fracture.Methods From March 2016 to January 2018,82 adult patients with midshaft clavicle fracture were treated in our department.According to different treatment methods,they were divided into two groups:26 cases in the intramedullary nailgroup with Robinson fracture classification of type 2A in 6 cascs,type 2Bi in 16 cases and type 2B2 in 4 cases;56 cases in the traditional incision plate group with Robinson fracture classification of type 2.A in 10 cases,type 2B1 in 26 cases and type 2B2 in 20 cases.The incision length of the first operation(the total length of two incisions in the intramedullary nail group),the first operation time,visual analogue scale(VAS)on the second day after operation,fracture healing time,Constant score and DASH score of shoulder joint function after operation,complications,incision length of internal fixation removal in the second operation and operation time were recorded.Results The intramedullary nail group and the traditional incision plate group were follow-up for(19.6±6.1)months and(21.8±7.6)months respectively.There was no significant difference in the general data between the two groups(P>0.05).They were comparable.There was no significant difference in VAS score on the second day after operation,Constant score and DASH score of shoulder joint function and complication rate between the two groups(P>0.05).The incision length and operation time in the intramedullary nail group were(4.6±1.2)cm and(60.3±23.9)min,which were shorter than those in the traditional incision plate group(11.5±2.2)cm and(79.1±26.9)min,and the difference was statistically significant(P<0.05).The fracture healing time in the intramedullary nail group was(12.0±1.3)weeks shorter than that in the traditional incision plate group(14.0±1.8)weeks.The length of incision and operation time of internal fixation removal in the second operation in the intramedullary nail group were(1.5±0.4)cm and(12.0±5.0)min,which were shorter than those in the traditional incision plate group(11.1±2.l)cm and(33.2±7.2)min,with statistically significant difference(P<0.05).Conclusion The Nice knot assisted intramedullary nailing in the treatment of adult midshaft clavicle fracture can obtain the same postoperative efficacy as the traditional incision plate fixation,but the surgical scar is obviously small,the soft tissue damage is light,and the risk of nerve injury in secondary operation can be avoided.