锁骨骨折开放复位内固定的并发症及处理

Complications secondary to open reduction and internal fixation of clavicular fractures and corresponding treatments

摘要:

［目的］ 探讨锁骨骨折开放复位内固定并发症的发生特点与处理结果。［方法］ 回顾性分析 2019 年 1 月 1 日—2020 年 12 月 31 日本院采用开放复位内固定治疗的锁骨骨折 228 例患者的临床资料。探讨并发症的发生情况与特点，以及处理和结局。［结果］ 228 例患者共 19 例发生并发症，占 8.3%。早期并发症 6 例，占 31.6%；晚期并发症 13 例，占 68.4%；差异有统计学意义（P<0.001）。按骨折部位并发症发生率：锁骨外侧骨折为 4/57（7.0%），锁骨中段骨折为 15/161（9.3%），锁骨内侧骨折为 0/5 （0.0%），双极骨折 0/5 （0.0%），差异有统计学意义 （P=0.023）。按内固定术式：锁骨钩钢板为 3/20 （15.0%），外侧端钢板合并喙锁间悬吊固定为 1/15（6.7%），单纯外侧端钢板固定为 0/22（0.0%）。锁骨中段钢板内固定 15/161（9.3%），锁骨内侧钢板固定为 0/5（0.0%），锁骨双钢板固定 0/5（0.0%），各种内固定间并发症发生率的差异有统计学意义（P=0.036）。具体并发症发生率由高至低依次为内固定取出后再骨折 7/19 （36.8%）、内固定断裂 6/19 （31.6%）、切口感染 3/19 （15.8%）、内固定松动 1/19 （5.3%）、内固定激惹 1/19 （5.3%） 和肩锁关节脱位 1/19 （5.3%）。各类并发症发生率的差异有统计学意义 （P= 0.018）。19 例患者中，4 例保守处理，15 例行翻修手术，均未发生严重不良后果。末次随访时，19 例患者中，15 例完全无痛，3 例活动时轻度疼痛，1 例明显疼痛；10 例肩关节活动不受限，6 例轻度受限，3 例明显受限；13 例恢复伤前运动和劳动能力，6 例未恢复至伤前运动劳动能力水平。［结论］锁骨骨折切开复位内固定是常规手术，并发症率仍高达 8.3%，最常见并发症是内固定取出后再骨折、内固定断裂、感染。提高手术技术是减少并发症的关键。

Abstract:

[Objective] To investigate the characteristics and management results of complications secondary to open reduction and in- ternal fixation (ORIF) of clavicle fractures. [Methods] A retrospective study was conducted on 228 patients who received ORIF of clavicle fractures in our hospital from January 2019 to December 2020. The occurrence, characteristics, management and outcome of complications were analyzed in this paper. [Results] Among 228 patients, 19 patients suffered from complications, accounting for 8.33%. In term of time of complication happened, the early complications were found in 6 cases, accounting for 31.57%, while late complications were seen in 13 cases, accounting for 68.4%, which was statistically significant (P=0.001) . In term of fracture site, the complication rate was 4/57(7.0%) in the lateral clavicle, 15/161 (9.3%) in the middle part of clavicle, 0/5 (0.0%) in the medial clavicle, whereas 0/5 (0.0%) in bipolar fracture with a statistically significant difference among the 4 parts (P=0.023) . In term of the internal fixation method, the complication rate proved 3/20 (15.0%) in the clavicle hook plate, 1/15 (9.3%) in the lateral end plate combined with the coracoclavicular suspension, 0/22 (0.0%) in the simple lateral end plate, 15/161 (9.3%) in mid-clavicle plate, while 0/5 (0.0%) in medial clavicle plate, which was statistically signifi- cant (P=0.036) . The incidence of specific complications ranked from high to low was of refracture after removal of internal fixation (7/19, 36.8%) , fracture of internal fixation (6/19, 31.6%) , incision infection (3/19, 15.8%) , irritation of internal fixation (1/19, 5.3%) and acromio- clavicular dislocation (1/19, 5.3%) with significant differences in the incidence of various complications (P=0.018) . Of the 19 patients, 4 cases were treated conservatively, whereas15 cases underwent revision surgery without serious adverse events. Of them, 15 patients had no pain at all, 3 patients had mild pain during activities, and 1 patients had obvious pain; 10 patients had no shoulder motion affected, 6 cases got mildly limited, and 3 case had significantly limited motion; 13 cases regained sports and labor capacity to the levels before injury, while 6 cases were under the levels at the latest follow-up. [Conclusion] Although ORIF of clavicle fractures is a routine operation, the complica- tion rate is still as high as 8.33%, including the most common complications of refracture after removal of internal fixation, fracture of inter- nal fixation and infection. Improving surgical technique is the key to reduce complications.