吴门医派可塑性夹板与钢板内固定治疗RobinsonⅡB型锁骨中段骨折的临床效果

Clinical effect of Wu Men Medical school plastic splint and plate internal fixation in the treatment of Robinson typeⅡB middle clavicle fractures

目的比较吴门医派可塑性夹板与钢板内固定治疗RobinsonⅡB型锁骨中段骨折的临床效果。方法选择2019年10月至2020年11月苏州市中医医院收治的67例RobinsonⅡB型锁骨中段骨折患者,将患者分为RobinsonⅡB1型和RobinsonⅡB2型,综合比较两种类型骨折患者数量。按比例抽取RobinsonⅡB1型35例及RobinsonⅡB2型32例,采用抽签法将患者分为可塑性夹板组与钢板内固定组。可塑性夹板组32例,采用手法复位及可塑性夹板治疗;钢板内固定组35例,采用切开复位钢板内固定治疗。比较两组治疗1、3、9个月后Constant-Murley肩关节评分、外观满意度及并发症发生率并进行效果评定。结果所有患者获得随访,时间9~12个月,平均(10.82±2.06)个月。两组治疗效果比较,差异无统计学意义(P>0.05)。两组Constant-Murley肩关节评分组间、时间点比较及交互作用比较,差异有统计学意义(P<0.05)。进一步两两比较:组内比较,两组治疗1、3、9个月后Constant-Murley肩关节评分高于治疗前,差异有统计学意义(P<0.05)。组间比较,钢板内固定组治疗1、3个月后Constant-Murley肩关节评分高于可塑性夹板组,差异有统计学意义(P<0.05);两组治疗9个月后Constant-Murley肩关节评分比较,差异无统计学意义(P>0.05)。可塑性夹板组外观满意度优于钢板内固定组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论吴门医派可塑性夹板治疗RobinsonⅡB型锁骨中段骨折较钢板内固定具有一定的优势,可作为一种供临床选择的治疗方式;采用内固定治疗应根据患者的自身条件和意愿综合制定标准。

Objective To compare the clinical effect of Wu Men Medical school’s plastic splint and plate internal fixation in the treatment of RobinsonⅡB middle clavicle fractures.Methods A retrospective analysis was performed on 67 patients with RobinsonⅡB middle clavicle fractures admitted to Suzhou Traditional Chinese Medicine Hospital from October 2019 to November 2020.The patients were divided into RobinsonⅡB1 and RobinsonⅡB2,and the number of patients with the two types of fractures was comprehensively compared.A total of 35 cases of RobinsonⅡB1 and 32 cases of RobinsonⅡB2 were selected according to the proportion,and the patients were divided into plastic splint group and plate internal fixation group by drawing lots.The plastic splint group of 32 cases was treated with manual reduction and plastic splint;the plate internal fixation group of 35 cases was treated with open reduction and internal fixation.The Constant-Murley shoulder joint score,appearance satisfaction,and complication rate were compared between the two groups after 1,3,and 9 months of treatment,and the efficacy was evaluated.Results All patients were followed up for 9 to 12 months,with an average of(10.82±2.06)months.There was no significant difference in the treatment effect between the two groups(P>0.05).There were statistically significant differences of the Constant-Murley shoulder joint score between the two groups,time point comparison and interaction comparison(P<0.05).Further pair-wise comparison:within-group comparison,the Constant-Murley shoulder joint scores of the two groups after 1,3,and 9 months of treatment were higher than those before treatment,and the differences were statistically significant(P<0.05).Compared between groups,the Constant-Murley shoulder joint scores in the plate internal fixation group were higher than those in the plastic splint group after 1 and 3 months of treatment,and the differences were statistically significant(P<0.05).There was no significant difference in the Constant-Murley shoulder joint score between the two groups after 9 months of treatment(P>0.05).The appearance satisfaction of the plastic splint group was better than that of the steel plate internal fixation group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Wu Men Medical school plastic splint has certain advantages over plate internal fixation in the treatment of RobinsonⅡB middle clavicle fractures compared with plate internal fixation,and can be used as a clinical treatment option.The use of internal fixation therapy should be based on the patient’s own conditions and wishes to comprehensively formulate standards.