解剖钢板与克氏针固定治疗锁骨中段骨折的对照研究

目的比较解剖钢板与克氏针固定治疗锁骨中段骨折的疗效。方法将2007年8月~2011年3月于我院治疗的108例锁骨中段骨折患者随机分为两组：解剖钢板组58例,克氏针组50例。比较两组手术时间、手术切口长度、内固定费用的差异;采用Constant肩关节评分系统比较两组术后3、6个月的肩关节功能评分。结果两组手术时间、手术切口长度、内固定费用差异有统计学意义（P〈0.05）。Constant肩关节评分：术后3个月解剖钢板组得分（72.01±8.64）分,克氏针组得分（45.25±7.51）分,两组比较,差异有高度统计学意义（t=-9.81,P=0）;术后6个月解剖钢板组得分（86.00±4.57）分,克氏针组得分（75.59±7.95）分,两组比较,差异有高度统计学意义（t=-5.17,P=0）;解剖钢板组及克氏针组术后3、6个月组内功能评分比较,差异均有高度统计学意义（t=-7.48、-13.20,P=0）。结论两种锁骨中段骨折固定方法相比,克氏针固定具有切口小、手术时间短、费用低的优势,解剖钢板固定可以取得更好的肩关节功能。因此,术前与患者充分沟通,根据其主观需求和客观情况制订个体化的治疗方案非常重要。

Controlled study between anatomical plate and Kuntscher wire fixation treatment for fracture of mid-shaft of clavicle

Objective To compare the effect of anatomical plate and Kuntscher wire fixation treatment for fracture of mid-shaft of clavicle.Methods 108 cases of patients with fracture of mid-shaft of clavicle treated in our hospital from August 2007 to March 2011 were selected and divided into two groups: 58 cases in anatomic plate group and 50 cases in Kirschner wire group.Difference in operation time,operation incision length and cost of internal fixation between the two groups were compared;Constant shoulder joint scoring system was used to compare shoulder joint function scores between the two groups at 3 and 6 months after operation.Results Operation time,length of operation incision and cost of internal fixation were statistically significant difference between the two groups(P < 0.05).Constant shoulder joint scoring: 3 months after operation,scoring of anatomic plate group was(72.01±8.64) scores,which of Kirschner wire group was(45.25±7.51) scores,the difference was statistically significant(t =-9.81,P = 0);6 months after operation,scoring of anatomic plate group was(86.00±4.57) scores,which of Kirschner wire group was(75.59±7.95) scores,the difference was statistically significant(t =-5.17,P = 0);differences in intra-group shoulder joint function scores of the two group between 3 and 6 months were statistically significant(t =-7.48,-13.20,P = 0).Conclusion Compared the two kinds of fixation methods for fracture of mid-shaft of clavicle,Kirschner wire fixation has advantage of small incision,short operation time and less cost,while anatomical plate can obtain better shoulder function.Therefore,before operation adequate communication should be carried out to patients,according to patients’ subjective demand and objective conditions to formulate individualized treatment plan is very important.