经皮微创解剖锁定钢板与切开复位重建钢板在锁骨中段粉碎性骨折中的应用效果对比

Comparison of Clinical Efficacy of Percutaneous Minimally Invasive Anatomical Locking Plate and Incision Reduction Reconstruction Plate in the Treatment of Comminuted Midshaft Clavicle Fractures

目的对比分析经皮微创解剖锁定钢板与切开复位重建钢板在锁骨中段粉碎性骨折内固定术中的应用效果。方法选取2020年1月至2022年1月驻马店市第一人民医院收治的90例锁骨中段粉碎性骨折患者作为研究对象,按照不同治疗方法将其分为微创组(45例)和传统组(45例),微创组患者采用经皮微创解剖锁定钢板内固定治疗,传统组患者采用切开复位重建钢板内固定治疗,对比观察两组患者围手术期相关指标、骨折愈合时间、临床疗效、肩关节及上肢功能、不良事件发生情况。结果微创组患者手术时间、住院时间、骨折愈合时间均明显短于传统组(t=5.069、3.494、4.007,P均<0.001);术后3个月,微创组患者中显效37例、有效7例、无效1例,与传统组患者的显效29例、有效14例、无效2例无明显差异(Z=-1.886,P=0.059);术后6个月,微创组患者Neer肩关节功能评分量表(Neer)评分明显高于传统组,上肢功能障碍评定量表(DASH)评分明显低于传统组(t=11.247、2.599,P<0.001、P=0.011);微创组患者不良事件发生率为6.7%,明显低于传统组患者的不良事件发生率22.2%(χ^(2)=4.406,P=0.036)。结论与切开复位重建钢板内固定相比,锁骨中段粉碎性骨折患者应用经皮微创锁定钢板内固定治疗的临床效果更佳,术后肩关节及上肢功能恢复效果更好,不良事件发生率更低。

Objective To compare the clinical efficacy of percutaneous minimally invasive anatomical locking plate and incision reduction reconstruction plate in the internal fixation of comminuted midshaft clavicle fractures.Methods 90 patients with comminuted midshaft clavicle fractures admitted to The First People’s Hospital of Zhumadian from January 2020 to January 2022 were enrolled as research subjects and divided into the minimally invasive group(n=45)and the traditional group(n=45)according to the different treatment methods they received.Patients in the minimally invasive group were treated with percutaneous minimally invasive anatomical locking plate fixation,whereas patients in the traditional group were treated with incision reduction reconstruction plate fixation.Perioperative indicators,fracture healing time,clinical efficacy,shoulder and upper extremity function,and occurrence of adverse events were compared between the two groups.Results The operation time,length of stay,and fracture healing time of patients in the minimally invasive group were significantly shorter than those in the traditional group(t=5069,3494 and 4007,all P<0001).At three months after surgery,37 cases were markedly effective,7 cases were effective,and 1 case was ineffective in the minimally invasive group,which showed no statistically significant difference compared with the traditional group(Z=-1886,P=0059)-markedly effective in 29 cases,effective in 14 cases and ineffective in 2 cases.Six months after surgery,the Neer shoulder function rating scale(Neer)score of patients in the minimally invasive group was significantly higher than that in the tradi-tional group,and the disability of arm,shoulder and hand(DASH)score was significantly lower in the minimally invasive group(t=11247 and 2599,P<0001,P=0011).The incidence of patients’adverse reactions in the minimally invasive group was 67%,much lower than the 222%in the traditional group(χ^(2)=4406,P=0036).Conclusion Compared with incision reduction reconstruction plate fixation,percutaneous minimally invasive anatomical locking plate fixation can realize better clinical efficacy and better recovery of shoulder and upper extremity function in the treatment of comminuted midshaft clavicle fractures,with a much lower incidence of adverse reactions.