锁骨近端骨折的手术治疗疗效观察

目的对治疗锁骨近端骨折的5种不同手术方案及其疗效进行探讨。方法将60例锁骨近端骨折具有手术指征者随机分为张力带钢丝内固定治疗组(Ⅰ组),锁骨钩钢板内固定治疗组(Ⅱ组),单纯T形钢板内固定治疗组(Ⅲ组),T形钢板内固定加一期植骨治疗组(Ⅳ组),各15例。比较4组治疗术式手术安全性及其临床疗效。结果 4组患者术后分别采用Rockwood胸锁关节评分法以及关节疾患治疗成绩制定标准(JOA)对其疗效进行评价,4组评分取均值对比:术后3个月Rockwood评分Ⅳ组(13.6±1.8)分,高于Ⅰ组(10.4±1.6)分,Ⅱ组(9.3±2.5)分和Ⅲ组(10.8±2.9)(P﹤0.05);术后6个月JOA评分Ⅳ组(95.7±2.8)分,高于Ⅰ组(91.0±1.3)分,Ⅱ组(89.3±2.2)分和Ⅲ组(91.8±1.8)(P﹤0.05);Ⅳ组术后优良率(100%)显著高于前3组,术后并发症发生率(0%)明显低于前3组。结论 T形钢板内固定加一期植骨治疗锁骨近段骨折,术后临床疗效确切,无并发症,固定可靠,值得临床推广使用。

Surgial treatment for the fracture of proximal clavicle

OBJECTIVE To investigate 5 different operation schemes and treatment effect of fracture of the proximal clavicle.METHODS 60 cases of fracture of the proximal clavicle with operation indications were randomized into wire tension band fixation treatment group(group I),clavicular hook plate fixation in the treatment group(group II),pure T shaped plate internal fixation in the treatment group(group III),T shaped plate internal fixation combined with one stage bone grafting in the treatment of group(Group IV),15 cases in each group.Compared with operation safety and clinical efficacy in the 4 groups.RESULTS The patients in the 4 groups after operation were evaluated respectively with Rockwood sternoclavicular joint scoring and joint diseases treatment performance standards(JOA)to know its efficacy.Compared means:3 months after operation,group IV had(13.6 ± 1.8)in Rockwood score,higher than group I(10.4 ± 1.6),group II(9.3 ± 2.5)and group III(10.8 ± 2.9)(P﹤0.05);6 months after operation,group IV had(95.7 ± 2.8)in JOA score,higher than group I(91 ± 1.3),group II(89.3 ± 2.2)and group III(91.8 ± 1.8)(P﹤0.05);after operation,the excellent and good rate(100%)in group IV was significantly higher than that former 3 groups,the incidence of postoperative complications(0%)was significantly lower than the former 3 group.CONCLUSION T shaped plate internal fixation combined with bone graft for the treatment of fracture of proximal clavicle has a curative effect,no complications,reliable fixation,which is worthy of clinical use.