Herbert钉髓内固定与重建钢板加压内固定治疗Robinson 2A2、2B1型锁骨中段骨折的比较

Herbert cannulated screw intramedullary fixation versus reconstruction plate compressive fixation for treatment of Robinson type 2A2 and 2B1 displaced midshaft clavicular fractures

目的比较Herbert钉髓内固定和重建钢板加压内固定治疗简单锁骨中段骨折的临床结果,探讨手术相关并发症情况。方法纳入自2011-06—2016-06采用内固定手术治疗的70例简单锁骨中段骨折(Robinson 2A2、2B1型),30例采用Herbert钉髓内固定(Herbert钉组),40例采用重建钢板加压内固定(重建钢板组)。比较两组切口长度、手术时间、术中出血量、骨折愈合时间、并发症情况,以及末次随访时肩关节功能DASH评分、Constant-Murley评分。结果 70例均获得随访,随访时间平均20.2(12~26)个月。Herbert钉组切口长度较重建钢板组短,手术时间较重建钢板组短,术中出血量较重建钢板组少,差异有统计学意义(P<0.05)。Herbert钉组与重建钢板组骨折愈合时间、末次随访时肩关节功能DASH评分、Constant-Murley评分比较差异无统计学意义(P>0.05)。重建钢板组内固定物导致的软组织激惹发生率、内固定物弯曲发生率、肩胸部感觉麻木发生率高于Herbert钉组,差异有统计学意义(P<0.05)。结论 Herbert钉髓内固定与普通重建钢板加压内固定治疗简单锁骨中段骨折均可获得满意的骨愈合与肩关节功能,Herbert钉髓内固定具有微创优势,软组织激惹、肩胸部感觉麻木发生率更低。

Objective To compare clinical results and operative complications of treatment for acute midshaft clavicular frac-tures with Herbert cannulated screw(HS) intramedullary fixation and reconstruction plate(RF) compressive fixation.Methods In this retrospective case-control study, 70 patients with simple displaced midshaft clavicular fractures(Robinson type 2A2 and 2B1) between June 2011 and June 2016 were included, 30 cases received fixation with Herbert cannulated screw(group HS) and 40 cases received fixation with reconstruction plate(group RF). Clinical data included length of incision, opera-tive time, amount of blood loss, times to bone union, perioperative complications, Constant-Murley score and DASH score werecompared between group HS and group RF.Results The mean follow-up period of all 70 cases was 20.2 months(12-26 months). Mean length of incision, operative time and amount of bleeding were significantly advantageous in group HS comparedwith group RF(P<0.05). There were no difference in the DASH and Constant-Murley scores and times to bone union in twogroups(P>0.05). Implant bending and skin irritation and loss of sensation were significantly more frequent in the group RF thangroup HS(P<0.05).Conclusion The results of bone union and shoulder function are satisfactory in the treatment of simplemidshaft clavicular fractures with either Herbert screw intramedullary fixation or conventional reconstruction plate compressivefixation. Herbert screw intramedullary fixation has the advantages of minimally invasion and lower incidence of soft tissue irrita-tion and numbness around shoulder and chest.