锁骨中段骨折两种内固定的比较△

Comparison of two internal fixations for midshaft clavicle fractures

摘要:

［目的］比较桥接内固定系统结合 Nice 结与钢板固定治疗锁骨中段骨折的临床疗效。［方法］回顾性分析 2019 年 1 月—2021 年 6 月本科收治的 62 例锁骨中段骨折患者的临床资料。根据医患沟通结果，28 例采用桥接内固定系统结合 Nice 结治疗（桥接组），34 例采用钢板内固定治疗（钢板组），比较两组围手术期、随访及影像结果。［结果］两组患者手术均顺利完成，均无血管、神经损伤等严重并发症。桥接组手术时间、术中出血量、恢复主动活动时间均显著优于钢板组 （P<0.05），两组切口长度、切口愈合等级、住院时间的差异均无统计学意义（P>0.05）。随时间推移，两组术后早期 VAS 评分显著减少（P> 0.05），相应时间点，两组间 VAS 评分的差异无统计学意义 （P>0.05）。两组患者均获随访 12 个月以上，桥接组恢复完全负重活动时间显著早于钢板组（P<0.05）。随术后时间推移，两组患者肩关节 Constant-Murley 评分均显著增加（P>0.05），相应时间点两组间 Constant-Murley 评分的差异均无统计学意义（P>0.05）。影像方面，桥接组骨折复位质量优于钢板组，但两组间差异无统计学意义（P>0.05），两组骨折愈合时间的差异无统计学意义（P>0.05）。［结论］桥接内固定系统结合 Nice 结固定锁骨中段骨折临床效果优于传统钢板内固定。

Abstract:

[Objective] To compare the clinical efficacy of the bridge-link fixation combined with Nice knot (BLFNK) versus plate for midshaft clavicular fractures. [Methods] A retrospective study was conducted on 62 patients who received open reduction and internal fixa- tion (ORIF) for midshaft clavicle fractures in our departments from January 2019 to June 2021. According to the results of doctor-patient communication, 28 patients were treated with BLFNK, while the remaining 34 patients had fractures fixed with plate. The documents re- garding to perioperative period, follow-up and imaging were compared between the two groups. [Results] All the patients in both groups had ORIF performed smoothly with no serious complications such as vascular and nerve injury. The BLFNK group proved significantly su- perior to the plate group in terms of operation time, intraoperative blood loss and time to return active activity (P＜0.05), although there were no significant differences in incision length, incision healing grade and hospital stay between the two groups (P＞0.05). The VAS scores for pain during the early postoperative period were significantly reduced over time in both groups (P＜0.05), which was not significantly differ- ent between the two groups at corresponding time points (P＞0.05). All of them in both groups were followed up for more than 12 months, and the BLFNK group resumed full weight-bearing activity significantly earlier than the plate group (P＜0.05). The Constant-Murley scores significantly increased in both groups over time after surgery (P＜0.05), which was not significantly different between the two groups at corre- sponding time points (P＞0.05). Radiographically, the BLFNK group got better fracture reduction quality than the plate group regardless of the fact that there was no statistical difference between the two groups (P＞0.05). In addition, there was no significant difference in fracture healing time between the two groups (P＞0.05). [Conclusion] The bridge-link fixation system combined with Nice knot achieves better clini- cal outcomes than the traditional plate internal fixation for midshaft clavicle fractures.