钢板前置与上置内固定治疗青年锁骨骨折的疗效比较

发布时间：2018-07-05 00:56

本文选题：锁骨骨折 + 前置钢板　；参考：《中国矫形外科杂志》2017年08期

【摘要】：[目的]探讨钢板前置内固定治疗青年锁骨骨折的临床疗效。[方法]回顾性分析2013年4月~2015年5月32例行切开复位锁骨前置钢板内固定术的青年锁骨骨折病例,并与同时期34例青年锁骨骨折上置钢板内固定患者作对照。术中对游离较大骨折块以拉力螺钉固定、较小骨块以粗丝线固定。术后4周、8周、12周、6个月及12个月进行随访,比较两组在手术时间、总出血量、并发症、骨折愈合、内固定、肩关节功能及钢板对皮肤顶压等情况。[结果]所有患者术后均获随访,时间12~36月,平均15.4个月。患者均无血管神经损伤、切口感染坏死及血气胸等围手术期并发症。前置钢板组的手术时间平均(50.2±14.5)min、总出血量平均(99.1±25.3)ml、骨折愈合时间(16.2±8.3)周、术后12个月肩关节功能Constant平均评分(87.3±4.5)分;上置钢板组的手术时间平均(47.6±16.5)min、总出血量平均(110.0±27.1)ml、骨折愈合时间(15.0±5.5)周、术后12月肩关节功能Constant评分平均(89.8±6.5)分,两组上述指标比较差异无统计学意义(P0.05)。上置钢板组1例术后2个月出现骨折轻度上下移位,内固定部分松动,局部制动后术后6个月轻度畸形愈合,3例女性患者术后1个月起诉钢板顶压皮肤突出引起生理及心理不适。前置钢板组1例延迟愈合,相对制动后术后10个月愈合,无钢板顶压皮肤导致的生理及心理不适患者。[结论]前置钢板内固定治疗青年锁骨骨折在获得满意临床疗效的同时能有效减少钢板顶压皮肤导致的不适及促进美观,是治疗青年锁骨骨折的一种良好选择方法。
[Abstract]:Objective: to investigate the clinical effect of anterior internal fixation with steel plate in the treatment of clavicular fracture in young people. [methods] 32 cases of young clavicle fracture treated with open reduction and anterior clavicle plate internal fixation from April 2013 to May 2015 were analyzed retrospectively and compared with 34 cases of young patients with clavicular fracture treated with upper plate internal fixation in the same period. The larger fractures were fixed with lag screws, and the smaller ones were fixed with coarse filaments. Four weeks, eight weeks, twelve weeks, six months and twelve months were followed up. The operation time, total bleeding volume, complications, fracture healing, internal fixation, shoulder joint function and skin top pressure were compared between the two groups. [results] all patients were followed up for 12 ~ 36 months (mean 15.4 months). There were no vascular and nerve injury, wound infection and necrosis, hemopneumothorax and other perioperative complications. The mean operative time was (50.2 卤14.5) min, the mean blood loss was (99.1 卤25.3) ml, the fracture healing time was (16.2 卤8.3) weeks, the mean constant score of shoulder joint function was (87.3 卤4.5) in 12 months after operation, the mean operative time was (47.6 卤16.5) min, the mean blood loss was (110.0 卤27.1) ml, and the fracture healing time was (15.0 卤5.5) weeks in the steel plate group, the average operative time was (47.6 卤16.5) min, the mean blood loss was (110.0 卤27.1) ml, and the fracture healing time was (15.0 卤5.5) weeks. The average constant score of shoulder joint function was (89.8 卤6.5) points in 12 months after operation, and there was no significant difference between the two groups (P0.05). In the upper plate group, 1 case had slight displacement of fracture and partial loosening of internal fixation 2 months after operation. Three female patients with mild malunion 6 months after local immobilization complained of physiological and psychological discomfort caused by skin herniation of steel plate at 1 month after operation. There was no physiological and psychological discomfort caused by top pressure of steel plate in one patient with delayed healing and 10 months after relative immobilization. [conclusion] anterior plate internal fixation in the treatment of young clavicle fracture can effectively reduce the discomfort caused by plate top compression skin and promote beauty. It is a good choice for the treatment of young clavicle fracture.
【作者单位】：同济大学附属同济医院骨科;
【分类号】：R726.8

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