弹性髓内针和钢板螺钉固定术治疗成人Allman Ⅰ型锁骨骨折的效果对比研究

Comparative Study on the Curative Effect of Elastic Intramedullary Needle and Plate Screw Internal Fixation in the Treatment of Adult Allman Type Ⅰ Clavicle Fractures

目的:弹性髓内针和钢板螺钉固定术治疗成人Allman Ⅰ型锁骨骨折的对比研究。方法:选取2019年1月-2020年6月在赣州市人民医院住院的52例成人Allman Ⅰ型锁骨骨折患者,按随机数字表法分为试验组和对照组,每组26例。对照组采用钢板螺钉内固定术治疗,试验组采用弹性髓内针固定术治疗。比较两组切口长度、手术时间、术中出血量、住院时间、术中透视次数及骨折愈合时间;比较两组肩关节功能评分(Constant)和上肢功能评分(DASH)及并发症发生情况。结果:试验组切口长度、手术时间、住院时间、术后骨折愈合时间均短于对照组,术中出血量少于对照组,但术中透视次数多于对照组,差异均有统计学意义(P<0.05)。术后1、4、6个月,试验组Constant评分均高于对照组,DASH评分均低于对照组,差异均有统计学意义(P<0.05)。试验组发生穿破骨皮质和钉尾皮肤刺激各1例,总发生率为7.69%(2/26),对照组骨折愈合迟缓3例,锁骨上神经损伤3例,软组织感染和皮肤愈合不良各1例,总发生率为30.77%(8/26)。两组并发症发生率比较,差异有统计学意义(P<0.05)。结论:弹性髓内针固定术治疗Allman Ⅰ型锁骨骨折创伤小,有利于患者骨折愈合,促进肩关节功能和上肢功能恢复,并发症少,值得临床借鉴。

Objective:To compare elastic intramedullary needle and plate screws internal fixation in the treatment of adult Allman type Ⅰ clavicle fractures.Method:A total of 52 adult patients with Allman type Ⅰ clavicle fractures who were hospitalized in Ganzhou People’s Hospital from January 2019 to June 2020 were selected,they were randomly divided into experimental group and control group according to random number table method,with 26 patients in each group.The control group was treated with plate screw internal fixation,and the experimental group was treated with elastic intramedullary needle fixation.The incision length,operation time,intraoperative blood loss,hospital stay,intraoperative fluoroscopy times,and fracture healing time were compared between two groups;the shoulder joint function score (Constant),the upper limb function score (DASH) and the incidence of complications were compared between the two groups.Result:The incision length,operation time,hospital stay and postoperative fracture healing time of the experimental group were shorter than those of the control group,and the intraoperative blood loss amount of the experimental group was less than that of the control group,but the intraoperative fluoroscopy number of the experimental group was more than that of the control group,the differences were statistically significant (P<0.05).At 1,4 and 6 months after surgery,Constant scores of the experimental group were higher than those of the control group,DASH scores of the experimental group were lower than those of the control group,the differences were statistically significant (P<0.05).In the experimental group,there was 1 case of skin irritation of broken bone cortex and 1 case of skin irritation of nail tail,with a total incidence of 7.69% (2/26).In the control group,there were 3 cases of delayed fracture healing,3 cases of supraclavicular nerve injury,1 case of soft tissue infection and 1 case of poor skin healing,with a total incidence of 30.77% (8/26).There was significant difference in the incidence of complications between two groups (P<0.05).Conclusion:Elastic intramedullary needle fixation in the treatment of Allman type Ⅰ clavicle fractures has less trauma,is conducive to fracture healing,promotes the recovery of shoulder joint function and upper limb function,and has fewer complications,which is worthy of clinical reference.