桥接组合内固定系统微创治疗锁骨中段骨折的疗效分析

Minimally invasive treatment of clavicular midshaft fracture with bridge-combined internal fixation system

目的探讨桥接组合内固定系统微创治疗锁骨中段骨折的临床疗效。方法回顾性分析2016年9月至2018年1月期间大理大学第一附属医院创伤骨科收治的54例锁骨中段骨折患者资料。根据治疗方式不同分为两组:观察组27例,男14例,女13例;年龄为(41.8±14.8)岁;骨折AO分型:6-A1型10例,6-C1型17例;采用小切口桥接组合内固定系统微创治疗。对照组27例,男15例,女12例;年龄为(39.6±14.1)岁;骨折AO分型:6-A1型11例,6-C1型16例;采用传统切开复位接骨板内固定。比较两组患者的手术时间、手术切口长度、术中出血量、骨折愈合时间、肩关节功能及术后并发症发生情况等。结果两组患者术前一般资料的比较差异均无统计学意义(P>0.05),具有可比性。54例患者术后获平均13个月(9~25个月)随访。观察组患者的手术切口长度为(4.34±0.65)cm,显著短于对照组患者[(10.64±2.14)cm];术中出血量为(20.9±6.2)mL,显著少于对照组患者[(40.7±13.5)mL];骨折愈合时间为(4.5±0.9)个月,显著短于对照组患者[(5.7±1.0)个月],差异均有统计学意义(P<0.05)。末次随访时肩关节功能根据Neer评分标准评定:观察组优22例,良4例,可1例,优良率为96.3%(26/27);对照组优21例,良4例,可1例,差1例,优良率为92.6%(25/27)。两组患者的手术时间和功能结果比较差异均无统计学意义(P>0.05)。对照组1例患者发生骨不连并钢板断裂。结论与传统切开复位接骨板固定相比,桥接组合内固定系统微创治疗锁骨中段骨折的手术创伤更小,切口更短,骨折愈合更快。

Objective To investigate the clinical effects of minimally invasive treatment of clavicular midshaft fracture with bridge-combined internal fixation system.Methods A retrospective analysis was conducted of the 54 patients with clavicular midshaft fracture who had been admitted to Department of Trauma Orthopedics,The First Affiliated Hospital to Dali University from September 2016 to January 2018.They were assigned into 2 groups according to different treatment methods.In the observation group of 27 patients who were subjected to minimally invasive treatment with bridge-combined internal fixation system,there were 14 males and 13 females with an age of(41.8±14.8)years,and 10 cases of type 6-A1 and 17cases of type 6-C1 by the AO classification.In the control group of 27 patients who were subjected to traditional open reduction and internal plate fixation,there were 15 males and 12 females with an age of(39.6±14.1)years,and 11 cases of type 6-A1 and 16 cases of type 6-C1 by the AO classification.The 2 groups were compared in terms of operation time,incision length,intraoperative blood loss,fracture healing time,shoulder functional recovery and incidence of postoperative complications.Results There was no significant difference between the 2 groups in their preoperative general data,showing comparability(P>0.05).The 54 patients were followed up for an average of 13 months(from 9 to 25 months).The observation group had an incision length of(4.34±0.65)cm,significantly shorter than that[(10.64±2.14)cm]in the control group,an intraoperative blood loss of(20.9±6.2)mL,significantly less than that[(40.7±13.5)mL]in the control group,and a fracture healing time of(4.5±0.9)months,significantly shorter than that[(5.7±1.0)months]in the control group(all P<0.05).According to the Neer scoring for shoulder function at the last follow-up,the observation group had 22 excellent,4 good and one fair cases,giving an excellent and good rate of 96.3%(26/27)while the control group had 21 excellent,4 good,one fair and one poor cases,giving an excellent and good rate of 92.6%(25/27).There was no significant difference in operation time or functional results between the 2 groups(P>0.05).One case of nonunion and plate breakage was observed in the control group.Conclusion In the treatment of clavicular midshaft fracture,compared with traditional open reduction and plate fixation,the bridge-combined internal fixation system may lead to less surgical trauma,a smaller incision and faster fracture healing.