[1]罗金金.经皮微创桥接组合式内固定系统内固定与切开复位重建钢板内固定治疗锁骨骨折的比较研究[J].中医正骨,2021,33(06):1-5.
　LUO Jinjin.A comparative study of minimally invasive percutaneous bridge combined fixation system internal fixation versus open reduction reconstruction plate internal fixation for treatment of clavicle fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(06):1-5.
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经皮微创桥接组合式内固定系统内固定与切开复位重建钢板内固定治疗锁骨骨折的比较研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年06期
页码:
1-5
栏目:
临床研究
出版日期:
2021-06-20

文章信息/Info

Title:
A comparative study of minimally invasive percutaneous bridge combined fixation system internal fixation versus open reduction reconstruction plate internal fixation for treatment of clavicle fractures
作者:
罗金金
余姚市中医医院,浙江 余姚 315400
Author(s):
LUO Jinjin
Yuyao Hospital of TCM,Yuyao 315400,Zhejiang,China
关键词:
骨折;  锁骨;  骨折固定术; 内;  骨板;  桥接组合式内固定系统
Keywords:
fractures; bone;  clavicle;  fracture fixation; internal;  bone plates;  bridge combined fixation system
摘要:
目的:比较经皮微创桥接组合式内固定系统(bridge combined fixation system,BCFS)内固定与切开复位重建钢板内固定治疗锁骨骨折的临床疗效和安全性。方法:回顾性分析2018年1月至2019年1月接受手术治疗的70例锁骨骨折患者的病例资料,根据手术方式分为2组,BCFS组37例(行经皮微创BCFS内固定)、重建钢板组33例(行切开复位重建钢板内固定)。比较2组患者手术时间、切口长度、术中出血量、骨折愈合时间及并发症发生率。比较2组患者术前和末次随访时测定的肩关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、肩关节日本骨科协会(Japanese Orthopaedic Association,JOA)评分和肩关节Neer评分。结果:2组患者均获随访,随访时间12～18个月,中位数15个月; 骨折均愈合,愈合时间6～16周,中位数11周。BCFS组手术时间、切口长度、骨折愈合时间均较重建钢板组短[(56.44±24.46)min,(67.56±34.84)min,t=4.451,P=0.012;(4.78±0.32)cm,(8.24±1.87)cm,t=8.893,P=0.001;(11.1±2.4)周,(13.2±2.8)周,t=9.883,P=0.001],术中出血量较重建钢板组少[(39.76±4.56)mL,(46.21±7.33)mL,t=9.384,P=0.000]。BCFS组术后并发骨折延迟愈合1例,重建钢板组术后并发切口感染4例、骨折延迟愈合2例、切口处瘢痕增生5例,BCFS组并发症发生率较重建钢板组低(χ2=9.466,P=0.002)。术前,2组患者肩关节疼痛VAS评分、肩关节JOA评分和Neer评分的组间差异均无统计学意义(t=0.521,P=0.641; t=0.873,P=0.511; t=0.958,P=0.348)。末次随访时,2组患者肩关节疼痛VAS评分均较术前降低[(8.85±1.43)分,(3.24±0.43)分,t=8.784,P=0.000;(8.42±0.87)分,(4.64±0.71)分,t=7.281,P=0.002],且BCFS组低于重建钢板组(t=6.533,P=0.017)。末次随访时,2组患者肩关节JOA评分和Neer评分均较术前提高[BCFS组:(39.46±5.32)分,(96.66±1.67)分,t=10.821,P=0.000;(71.22±8.77)分,(98.25±1.33)分,t=9.782,P=0.000。重建钢板组:(36.73±5.41)分,(90.33±1.73)分,t=10.267,P=0.000;(69.74±9.68)分,(92.47±2.73)分,t=7.892,P=0.005],且BCFS组均高于重建钢板组(t=4.815,P=0.005; t=8.248,P=0.000)。结论:与切开复位重建钢板内固定相比,经皮微创BCFS内固定治疗锁骨骨折创伤小、骨折愈合时间短、术后肩关节疼痛缓解更明显、更有利于肩关节功能恢复,且安全性高。
Abstract:
Objective:To compare the clinical curative effects and safety of minimally invasive percutaneous bridge combined fixation system(BCFS)internal fixation versus open reduction reconstruction plate(RP)internal fixation in treatment of clavicle fractures.Methods:The medical records of 70 patients who received surgical treatment for clavicle fractures from January 2018 to January 2019 were analyzed retrospectively.The patients were divided into 2 groups according to the surgical methods,37 patients were treated with minimally invasive percutaneous BCFS internal fixation(BCFS group),while the rest with open reduction RP internal fixation(RP group).The operative time,incision length,intraoperative blood loss,fracture healing time and complication incidence were compared between the 2 groups,and the shoulder pain visual analogue scale(VAS)scores,Japanese Orthopaedic Association(JOA)shoulder scores as well as Neer shoulder scores obtained before the surgery and at last follow-up were also compared between the 2 groups respectively.Results:All patients in the 2 groups were followed up for 12-18 months with a median of 15 months,and all fractures healed in the 2 groups for 6-16 weeks with a median of 11 weeks.The operative time,incision length and fracture healing time were shorter,and the intraoperative blood loss was less in BCFS group compared to RP group(56.44±24.46 vs 67.56±34.84 minutes,t=4.451,P=0.012; 4.78±0.32 vs 8.24±1.87 cm,t=8.893,P=0.001; 11.1±2.4 vs 13.2±2.8 weeks,t=9.883,P=0.001; 39.76±4.56 vs 46.21±7.33 mL,t=9.384,P=0.000).After the surgery,the delayed union of fracture(1 case)was found in BCFS group,while the incision infection(4 cases),delayed union of fracture(2 cases)and cicatrix hyperplasia around the incision(5 cases)were found in RP group.The postoperative complication incidence rate was lower in BCFS group compared to RP group(χ2=9.466,P=0.002).There was no statistical difference in shoulder pain VAS scores,JOA shoulder scores and Neer shoulder scores between the 2 groups before the surgery(t=0.521,P=0.641; t=0.873,P=0.511; t=0.958,P=0.348).The shoulder pain VAS scores decreased in the 2 groups at last follow-up compared to pre-surgery(8.85±1.43 vs 3.24±0.43 points,t=8.784,P=0.000; 8.42±0.87 vs 4.64±0.71 points,t=7.281,P=0.002),and were lower in BCFS group compared to RP group(t=6.533,P=0.017); while the JOA shoulder scores and Neer shoulder scores increased in the 2 groups at last follow-up compared to pre-surgery(BCFS group:39.46±5.32 vs 96.66±1.67 points,t=10.821,P=0.000; 71.22±8.77 vs 98.25±1.33 points,t=9.782,P=0.000.RP group:36.73±5.41 vs 90.33±1.73 points,t=10.267,P=0.000; 69.74±9.68 vs 92.47±2.73 points,t=7.892,P=0.005),and were higher in BCFS group compared to RP group(t=4.815,P=0.005; t=8.248,P=0.000).Conclusion:The minimally invasive percutaneous BCFS internal fixation has such advantages as less trauma and shorter fracture healing time,and it can better relieve postoperative shoulder pain and be more conducive to shoulder function recovery compared to open reduction RP internal fixation in treatment of clavicle fractures,and it exhibits high safety.

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更新日期/Last Update: 2021-12-20