微创经皮锁定钢板与空心螺钉髓内固定治疗锁骨骨折疗效比较

目的比较微创经皮锁定钢板与空心螺钉髓内固定治疗锁骨骨折的临床疗效。方法2011年1月~2012年12月收治锁骨骨折患者76例,分别采用经皮锁定钢板内固定(经皮锁定钢板组,40例)和空心螺钉髓内固定(空心螺钉组,36例)微创手术进行治疗。观察两组术中出血量、手术时间、住院时间、术后并发症发生率以及骨折愈合时间、肩关节功能Neer评分,并进行对比研究。结果两组76例患者均顺利完成手术,无一例发生锁骨劈裂,所有伤口均Ⅰ期愈合。与经皮锁定钢板组比较,空心螺钉组平均手术时间短((35.8±6.6)min VS(56.2±7.4)min),术中出血量少((25.3±9.7)ml VS(43.1±9.5)ml),差异均具有统计学意义(P0.05)。但两组间住院时间及骨折愈合时间比较,差异均无统计学意义(P0.05)。两组术后均无一例发生感染、局部皮肤坏死、骨折不愈合等其他并发症。术后空心螺钉组有3例患者出现轻度旋转改变,予以锁骨带保护3~4周后,骨折顺利愈合。空心螺钉组肩关节功能Neer评分高于经皮锁定钢板组((96.3±3.3)VS(92.6±2.9)),差异具有统计学意义(P0.05)。结论与微创经皮锁定钢板内固定术相比较,空心螺钉髓内固定治疗锁骨骨折具有术中出血少、手术时间短及功能恢复好的优势;只要掌握好其适应证,可获得更好的临床疗效。

Effect Comparison on Internal Fixation between Mini-invasive Percutaneous Plate Osteosynthesis and Cannulate Screw for Clavicle Fractures

Objective To compare the curative effect between internal fixation of mini-invasive percutaneous locking plate osteosynthesis and cannulate screw for clavicle fractures. Methods From January 2011 to December 2012, a total of 76 cases suffered clavicle fractures were analyzed retrospectively. Among them, 40 cases were received internal fixation of mini-invasive percutaneous locking plate （ regarded as percutaneous locking plate group） , and the other 36 cases were performed intramedullary fixation with cannulate screw （regarded as cannulate screw group）. The intraoperative blood loss, operative duration, hospital stays time, postoperative complication rate, fracture healing time and Neer score of shoulder function was compared between two groups. Results All 76 cases were completed the operation successfully without clavicle splitting. The operative time and intraoperative blood loss was 35.8 ± 6.6 min and 25.3 ± 9.7 ml respectively in cannulate screw group, both were less than 56.2 ± 7.4 min and 43.1 ± 9.5 ml respectively in percutaneous locking plate group, there were statistic difference between two groups （ P 〈 0.05 ）. But no statistic difference was found in hospital stay time and fracture healing time between two groups （P 〉 0.05）. No serious postoperative complicates such as infection, local cutaneous necrosis and fracture nonunion were occurred. The Neer score of postoperative shoulder function was 96.3± 3.3 in cannulate screw group, and was higher than 92.6 ± 2.9 in percutaneous locking plate group, there was statistic difference between two groups （P 〈 0.05）. Conclusion Compared to mini-invasive percutaneous plate osteosynthesis, the intramedullary fixation of cannulate screw can achieved more ideal effect with advantages as less blood loss, shorter postoperative hospital stays and good functional recovery.