微创空心螺钉髓内固定治疗锁骨骨折

目的 探讨微创空心螺钉髓内固定治疗锁骨骨折的手术方法及临床疗效.方法 回性性分析2009年4月至2010年10月采用微创空心螺钉髓内固定治疗65例获得随访的锁骨骨折患者资料,男41例,女24例；年龄19～67岁,平均(35.8±17.6)岁；根据Craig分型,Ⅰ型29例,Ⅱ-Ⅱ型36例.沿锁骨前缘做横切口,骨折远、近端暴露比例大致为2∶3.髓内向远折端肩峰穿入引导针,骨折复位后将引导针逆行回穿入骨折近端,空心螺钉加压固定.术后采用Neer肩关节活动评分评价患肩功能.选取同组医生以往采用重建钢板固定的65例患者进行对照研究,研究项目包括手术时间、术中出血量、骨折愈合时间、Neer肩关节活动评分及并发症.结果 空心螺钉组切口长度为4～5 cm,重建钢板组为10～11 cm.随访摄X线片证实两组患者骨折均愈合,空心螺钉组骨折愈合时为(13.2±6.9)周,重建钢板组为(16.3±8.7)周；两组患者随访时间均为6～20个月,平均10.6个月.空心螺钉组Neer肩关节活动评分为(96.6±3.4)分,重建钢板组为(94.2±5.8)分.两组均无一例发生感染、局部皮肤坏死、骨折不愈合等并发症.空心螺钉组随访期间出现退钉5例、骨折移位3例,予控制活动后骨折愈合；重建钢板组有4例皮缘愈合略差,经间断拆线换药后切口愈合.骨折愈合后,空心螺钉组在门诊局麻下取出空心螺钉,重建钢板组住院在臂丛麻醉下取出重建钢板.空心螺钉组与对照组骨折愈合时间比较,差异有统计学意义；两组Neer肩关节功能评分比较,差异无统计学意义.结论 微创空心螺钉髓内固定治疗锁骨骨折具有创伤小、骨折愈合快,且节约医疗费用等优势.

Minimally invasive treatment of clavicle fracture with a hollow screw

Objective To evaluate the clinical effect of minimally invasive treatment of clavicle fracture with a hollow screw. Methods Data of 65 patients, who had undergone minimally invasive treatment with a hollow screw for clavicle fracture from April 2009 to October 2010, were retrospectively analyzed. There were 41 males and 24 females, aged from 19 to 67 years (average, 35.8 years). According to the Craig's classification, there were 29 of group I and 36 of group II-II. A 4-5 cm transverse incision was made to expose the clavicle fracture. A guide pin was inserted into the marrow cavity, and then moved towards the acromion, after the fracture was reduced the pin was moved back to the proximal clavicle, finally a hollow screw was implanted to fix the fracture. The Neer score was used to evaluate the function of the shoulder. Radiographs were taken to observe the condition of the fracture union. The operative duration, intra-operative blood loss, fracture healing time, Neer score, and complications were compared with those of 65 patients with clavicle fracture who were treated by the same surgeons with plates. Results The incision length was 4-5 cm in hollow screw group and 10-11 cm in plate group. X-rays showed bone union was achieved in both groups, and the average bone healing time was 13.2±6.9 weeks in hollow screw group and 16.3±8.7 weeks in plate group. All patients were followed up for 6 to 20 months (average, 10.6 months). The average Neer score was 96.6±3.4 in hollow screw group and 94.2±5.8 in plate group. There was no infection, local skin necrosis and fracture nonunion in both groups. In hollow screw group, screw loosing occurred in 5, and fracture displacement in 3, fortunately, the fracture healed by controlling activities. There was a significant difference in fracture healing time between two groups. However, no significant difference was observed between two groups in Neer score. Conclusion Minimally invasive treatment of clavicle fracture with a hollow screw has several advantages, such as mini-invasion, short bone healing time, good clinical outcomes, and lower expense.