开放与微创技术治疗锁骨中外1/3骨折的临床效果比较(1)
[摘要]目的 比较开放与微创技术治疗锁骨中外1/3骨折的临床效果。方法 回顾性分析2015年1月～2018年1月我院收治的70例锁骨中外1/3骨折患者的临床资料，根据治疗方法的不同将其分为开放组及微创组，每组各35例。开放组患者采用切开复位内固定治疗，微创组患者采用闭合复位内固定治疗。比较两组患者的手术时间、手术出血量、骨折愈合时间，术后采用肩关节活动(Neer)评分评价两组的患肩功能。结果 微创组患者的手术出血量少于开放组，手术时间及骨折愈合时间均短于开放组，差异有统计学意义(P<0.05);两组患者的Neer评分比较，差异无统计学意义(P>0.05)。结论 采用微创技术置入钢板内固定治疗锁骨中外1/3骨折，具有手术时间短、出血量少、愈合快等优点，值得临床推广。
[关键词]开放及微创技术;内固定;锁骨骨折
[中图分类号] R683.41 [文献标识码] A [文章编号] 1674-4721(2019)7(a)-0149-04
[Abstract] Objective To compare the clinical effect of open and minimally invasive techniques in the treatment of 1/3 fracture of the middle and outer clavicle. Methods The clinical data of 70 patients with 1/3 fracture of the middle and outer clavicle treated in our hospital from January 2015 to January 2018 were retrospectively analyzed， and they were divided into the open group and the minimally invasive group according to different treatment methods， 35 cases in each group. Patients in the open group were treated with open reduction and internal fixation， and patients in the minimally invasive group were treated with closed reduction and internal fixation. The operation time， surgical bleeding volume， and fracture healing time were compared between the two groups. The shoulder joint activity (new experimental experience rating， Neer) score was used to evaluate the shoulder function of the two groups after operation. Results The amount of surgical bleeding in the minimally invasive group was less than that in the open group， the operation time and fracture healing time were shorter than those in the open group， and the differences were statistically significant (P<0.05). There was no significant difference in the Neer score between the two groups (P>0.05). Conclusion The minimally invasive technique has the advantages of short operation time， less bleeding volume and quick healing in the treatment of 1/3 fracture of the middle and outer clavicle， which is worthy of clinical promotion.
[Key words] Open and minimally invasive techniques; Internal fixation; Clavicular fracture
锁骨骨折比较常见，全身各个部位骨折的6%以上为锁骨骨折[1]，锁骨具有连接机体上肢和躯干的骨性支架作用[2]，主要发生在锁骨中外1/3(占76%～82%)。由于锁骨中外1/3直径最小，无韧带及肌肉附着，是前弓、后弓及扁平状骨与棱柱状骨交界部位，因此易发生骨折。病因多為高能量损伤，如高处跌伤及机动车发生事故，直接暴力导致的损伤，常见于青少年及成年人;而低能量损伤多为间接暴力，常见于儿童及老年人[3]。锁骨骨折的发生机制多为直接暴力导致的损伤，94%的锁骨骨折患者为肩关节直接受到暴力损伤的[4]。锁骨骨折为肩部损伤常见的骨折，其治疗的方法有手法复位外固定及切开复位内固定[5-6]，而微创手术为目前新型手术方式。保守治疗的方式包括“8”字绷带固定法、锁骨带固定法、石膏背心固定法等[7-8]，因保守治疗固定时间较长及可能导致骨折再次移位、压疮、骨折畸形愈合影响美观等并发症，故目前多数的医生及患者乐意选择手术治疗[9]。骨科技术的提高及人们生活水平的提高，越来越多的患者倾向于手术治疗。目前手术治疗有克氏针内固定及钢板内固定，其中钢板内固定可在直视下达到解剖复位及坚强内固定[10-11]，多数患者选择钢板内固定手术治疗。故有经验的骨科医师在手术时，充分利生物学内固定(BO)原则，尽量保留骨折附近的附丽软组织，减少血运破坏，根据生物力学原理选择合适长度的钢板，骨折的远端及近端分别拧入3颗螺钉固定[12]。本研究回顾性分析我院收治的70例锁骨中外1/3骨折患者的临床资料，旨在探讨开放与微创技术治疗锁骨中外1/3骨折的临床效果，现报道如下。, http://www.100md.com(吴锋 叶劲 刘金全)
[关键词]开放及微创技术;内固定;锁骨骨折
[中图分类号] R683.41 [文献标识码] A [文章编号] 1674-4721(2019)7(a)-0149-04
[Abstract] Objective To compare the clinical effect of open and minimally invasive techniques in the treatment of 1/3 fracture of the middle and outer clavicle. Methods The clinical data of 70 patients with 1/3 fracture of the middle and outer clavicle treated in our hospital from January 2015 to January 2018 were retrospectively analyzed， and they were divided into the open group and the minimally invasive group according to different treatment methods， 35 cases in each group. Patients in the open group were treated with open reduction and internal fixation， and patients in the minimally invasive group were treated with closed reduction and internal fixation. The operation time， surgical bleeding volume， and fracture healing time were compared between the two groups. The shoulder joint activity (new experimental experience rating， Neer) score was used to evaluate the shoulder function of the two groups after operation. Results The amount of surgical bleeding in the minimally invasive group was less than that in the open group， the operation time and fracture healing time were shorter than those in the open group， and the differences were statistically significant (P<0.05). There was no significant difference in the Neer score between the two groups (P>0.05). Conclusion The minimally invasive technique has the advantages of short operation time， less bleeding volume and quick healing in the treatment of 1/3 fracture of the middle and outer clavicle， which is worthy of clinical promotion.
[Key words] Open and minimally invasive techniques; Internal fixation; Clavicular fracture
锁骨骨折比较常见，全身各个部位骨折的6%以上为锁骨骨折[1]，锁骨具有连接机体上肢和躯干的骨性支架作用[2]，主要发生在锁骨中外1/3(占76%～82%)。由于锁骨中外1/3直径最小，无韧带及肌肉附着，是前弓、后弓及扁平状骨与棱柱状骨交界部位，因此易发生骨折。病因多為高能量损伤，如高处跌伤及机动车发生事故，直接暴力导致的损伤，常见于青少年及成年人;而低能量损伤多为间接暴力，常见于儿童及老年人[3]。锁骨骨折的发生机制多为直接暴力导致的损伤，94%的锁骨骨折患者为肩关节直接受到暴力损伤的[4]。锁骨骨折为肩部损伤常见的骨折，其治疗的方法有手法复位外固定及切开复位内固定[5-6]，而微创手术为目前新型手术方式。保守治疗的方式包括“8”字绷带固定法、锁骨带固定法、石膏背心固定法等[7-8]，因保守治疗固定时间较长及可能导致骨折再次移位、压疮、骨折畸形愈合影响美观等并发症，故目前多数的医生及患者乐意选择手术治疗[9]。骨科技术的提高及人们生活水平的提高，越来越多的患者倾向于手术治疗。目前手术治疗有克氏针内固定及钢板内固定，其中钢板内固定可在直视下达到解剖复位及坚强内固定[10-11]，多数患者选择钢板内固定手术治疗。故有经验的骨科医师在手术时，充分利生物学内固定(BO)原则，尽量保留骨折附近的附丽软组织，减少血运破坏，根据生物力学原理选择合适长度的钢板，骨折的远端及近端分别拧入3颗螺钉固定[12]。本研究回顾性分析我院收治的70例锁骨中外1/3骨折患者的临床资料，旨在探讨开放与微创技术治疗锁骨中外1/3骨折的临床效果，现报道如下。, http://www.100md.com(吴锋 叶劲 刘金全)