经皮微创桥接组合式内固定系统治疗锁骨骨折临床效果分析

Clinical effect analysis of percutaneous minimally invasive bridging combined internal fixation system in the treatment of clavicle fractures

目的观察经皮微创桥接组合式内固定系统(BCFS)治疗锁骨骨折的临床效果。方法前瞻性研究纳入华北医疗集团峰峰总医院2019年6月至2022年6月收治的锁骨骨折患者164例,按照随机数字表法分为研究组与对照组各82例,对照组以重建钢板内固定术治疗,研究组以经皮微创BCFS术治疗。比较手术相关指标、疼痛程度、肩关节功能、并发症及治疗效果。结果研究组术中出血量少于对照组[(43.81±5.29)ml比(58.79±6.85)ml],手术时间、骨折愈合时间短于对照组[(52.06±7.74)min比(67.24±8.28)min、(12.42±2.36)周比(14.50±3.08)周],差异有统计学意义(P<0.05),两组住院时间比较差异无统计学意义(P>0.05);两组术后12、24 h的疼痛视觉模拟量表(VAS)评分均低于术前,研究组术后12、24 h的VAS评分低于对照组[(4.15±0.69)分比(5.68±0.82)分和(2.95±0.62)分比(3.46±0.73)分],差异有统计学意义(P<0.05);术后6个月,研究组和对照组肩关节功能疼痛程度、肩关节活动度、日常生活、肌力及总分均高于术前[(10.87±3.25)分比(4.15±1.08)分和(10.52±3.19)分比(4.09±1.12)分、(31.24±5.13)分比(16.83±3.39)分和(30.52±4.85)分比(17.21±3.47)分、(16.06±3.12)分比(7.86±1.15)分和(15.73±3.58)分比(6.94±1.17分)、(20.67±2.62)分比(8.78±2.34)分和(21.06±3.48)分比(9.04±3.07)分、(78.84±7.16)分比(37.62±5.09)分和(77.83±6.04)分比(37.28±6.11)分],差异有统计学意义(P<0.05),而两组间术后6个月疼痛程度、肩关节活动度、日常生活、肌力及总分比较差异均无统计学意义(P>0.05);术后6个月,研究组并发症发生率低于对照组[4.88%(4/82)比14.64%(12/82)],差异有统计学意义(P<0.05);术后6个月,观察组总优良率高于对照组[98.78%(81/82)比89.02%(73/82)],差异有统计学意义(P<0.05)。结论经皮微创BCFS术治疗锁骨骨折疗效显著,有利于减少患者术中出血量,缩短手术时间,促进骨折愈合,减轻术后疼痛感,改善肩关节功能及降低并发症发生率,在锁骨骨折治疗中更具有优势。

ObjectiveTo observe the clinical efficacy of percutaneous minimally invasive bridging combined internal fixation system(BCFS)in the treatment of clavicle fractures through a prospective study.MethodsOne hundred and sixty-four patients with clavicle fractures admitted to Fengfeng General Hospital of North China Medical Group from June 2019 to June 2022 were included as the study subjects.They were randomly divided into study group and control group with 82 cases each using random number table method.The control group was treated with reconstruction steel plate internal fixation surgery,while the study group was treated with percutaneous minimally invasive BCFS surgery.Compare surgical related indicators,degree of pain,shoulder joint function,complications and treatment outcomes.ResultsThe intraoperative blood loss in the study group was less than that in the control group:(43.81±5.29)ml vs.(58.79±6.85)ml,and the surgical time and fracture healing time were shorter than those in the control group:(52.06±7.74)min vs.(67.24±8.28)min,(12.42±2.36)weeks vs.(14.50±3.08)weeks,with statistically significant differences(P<0.05).There was no statistical difference in the hospital stay between two groups(P>0.05).The visual analog scale(VAS)scores of both groups at 12 and 24 h after surgery were lower than before surgery.The VAS scores at 12 and 24 h after surgery in study group were lower than those in control group:(4.15±0.69)points vs.(5.68±0.82)points and(2.95±0.62)points vs.(3.46±0.73)points,with statistical significances(P<0.05).After 6 months of surgery,the shoulder joint function indexes were higher than before surgery,pain degree:(10.87±3.25)points vs.(4.15±1.08)points,(10.52±3.19)points vs.(4.09±1.12)points,and the shoulder joint range of motion:(31.24±5.13)points vs.(16.83±3.39)points,(30.52±4.85)points vs.(17.21±3.47)points,daily life:(16.06±3.12)points vs.(7.86±1.15)points,(15.73±3.58)points vs.(6.94±1.17)points,muscle strength:(20.67±2.62)points to(8.78±2.34)points,(21.06±3.48)points to(9.04±3.07)points,and total scores:(78.84±7.16)points vs.(37.62±5.09)points,(77.83±6.04)points vs.(37.28±6.11)points,the differences were statistically significant(P<0.05),while there were no statistically significant differences in pain level,shoulder joint range of motion,daily life,muscle strength and total score at 6 months after surgery between the two groups(P>0.05).After 6 months of surgery,the incidence of complications in the study group was lower than that in the control group:4.88%(4/82)vs.14.64%(12/82),and the difference was statistically significant(P<0.05).After 6 months of surgery,the overall excellent and good rate in the observation group was better than that in the control group:98.78%(81/82)vs.89.02%(73/82),with a statistically significant difference(P<0.05).ConclusionsThe percutaneous minimally invasive BCFS surgery has a significant therapeutic effect on clavicle fractures,which is beneficial for reducing intraoperative bleeding,shortening surgical time,promoting fracture healing,reducing postoperative pain,improving shoulder joint function,and reducing the incidence of complications.It has more advantages in the treatment of clavicle fractures.