Saber切口与锁骨上横切口在锁骨肩峰端骨折内固定术中的应用效果比较

Comparison of Saber Incision and Supraclavicular Transverse Incision in Internal Fixation of Clavicular Acromion Fracture

目的:探究Saber切口与锁骨上横切口在锁骨肩峰端骨折内固定术中的应用效果。方法:选取笔者医院2017年2月-2019年2月锁骨肩峰端骨折患者102例作为研究对象,按照随机数字表法分组,各51例。锁骨上横切口组采取锁骨上横切口内固定术治疗,Saber切口组采取Saber切口内固定术治疗。比较两组手术情况,检测术前及术后1 d、3 d、7 d手术创伤指标[血清肿瘤坏死因子α(Tumor necrosis factorα,TNF-α)、白细胞介素-10(Interleukin-10,IL-10)、促肾上腺皮质激素(Adrenocorticotropic hormone,ACTH)、谷胱甘肽过氧化物酶(Glutathione peroxidase,GSH-Px)],评价疼痛情况[McGill疼痛问卷(Short-form of McGill pain questionnaire,SF-MPQ)包括主观疼痛程度(Visual analogue scale,VAS)评分、疼痛评级指数(Pain rating index,PRI)评分、疼痛状况(Present pain intensity,PPI)评分],并于术前、术后3个月、6个月对肩关节功能恢复情况进行评定(Constant-Murley评分),比较术后6个月肩关节恢复优良率、切口情况[患者瘢痕自我评分(Patient scar assessment scale,PSAS)、切口美观满意度]。结果:Saber切口组术中失血量少于锁骨上横切口组,住院时间短于锁骨上横切口组,差异有统计学意义(P<0.05)。Saber切口组术后1 d、3 d、7 d血清TNF-α、IL-10、ACTH水平低于锁骨上横切口组,GSH-Px水平高于锁骨上横切口组,差异有统计学意义(P<0.05)。Saber切口组术后1 d、3 d、7 d VAS、PRI、PPI评分低于锁骨上横切口组,差异有统计学意义(P<0.05)。两组术后3个月、术后6个月肩关节疼痛程度、关节活动度、肌力、日常生活能力及Constant-Murley总分均高于术前,差异有统计学意义(P<0.05);但组间比较差异无统计学意义(P>0.05)。Saber切口组术后6个月肩关节功能优良率与锁骨上横切口组比较差异无统计学意义(P>0.05)。Saber切口组PSAS评分低于锁骨上横切口组,切口美观满意度高于锁骨上横切口组,差异有统计学意义(P<0.05)。结论:Saber切口与锁骨上横切口应用于锁骨肩峰端骨折患者术后肩关节功能恢复效果相当,但Saber切口内固定术能有效减少术中失血量,减轻手术创伤,降低疼痛程度,缩短住院时间,提高切口美观效果。

Objective To explore the application effect of Saber incision and supraclavicular transverse incision in internal fixation of clavicular acromion fracture.Methods A total of 102 patients with acromion fractures of the clavicle in our hospital from February 2017 to February 2019 were selected as the research objects,and they were divided into groups according to the random number table method,with 51 cases in each group.The supraclavicular transverse incision group was treated with supraclavicular transverse incision internal fixation surgery,and the Saber incision group was treated with Saber incision internal fixation surgery.The surgical conditions of the two groups were compared.The indexes of surgical trauma(TNF-α,IL-10,ACTH,GSH-Px)were measured before operation and 1,3 and 7 days after operation.The pain of the two groups was evaluated(including VAS score,PRI score and PPI score).The functional recovery of shoulder joint was evaluated before operation,3 months and 6 months after operation(Constant-Murley score).The excellent and good rate of shoulder joint recovery and incision(PSAS score and satisfaction with incision aesthetics)were compared between the two groups 6 months after operation.Results The intraoperative blood loss in the Saber incision group was less than that in the supraclavicular transverse incision group,and the hospital stay was shorter than that in the supraclavicular transverse incision group,the differences were statistically significant(P<0.05).The level of serum TNF-α,IL-10,ACTH in the Saber incision group was lower than those in the supraclavicular transverse incision group at 1,3 and 7 days after operation,and the level of GSH-Px was higher than that in the supraclavicular transverse incision group(P<0.05).The scores of VAS,PRI and PPI in the Saber incision group were lower than those in the supraclavicular transverse incision group at 1,3 and 7 days after operation(P<0.05).At 3 months and 6 months after operation,the degree of shoulder pain,joint range of motion,muscle strength,activity of daily living and the total score of Constant-Murley in the two groups were higher than those before operation(P<0.05).However,there were no significant difference between the two groups(P>0.05).There were no significant difference in the excellent and good rate of shoulder function between Saber incision group and supraclavicular transverse incision group 6 months after operation(P>0.05).The PSAS score of the Saber incision group was lower than that of the supraclavicular transverse incision group,and the aesthetic satisfaction of incision was higher than that of the supraclavicular transverse incision group(P<0.05).Conclusion The Saber incision and supraclavicular transverse incision have the same effect in the recovery of shoulder joint function in patients with clavicle acromion fractures,and the internal fixation of Saber incision can effectively reduce blood loss during operation,reduce surgical trauma,reduce pain,shorten hospitalization time,and improve the aesthetic effect of incision.