中国修复重建外科杂志

中国修复重建外科杂志

新型胸锁关节解剖锁定钢板的研制与临床应用

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目的报道一种新型胸锁关节解剖锁定钢板,探讨其治疗胸锁关节骨折脱位的疗效。方法研制一种符合国人胸锁关节解剖特点及生物力学特性的新型胸锁关节解剖锁定钢板。采用临床随机对照研究方法,将 2008 年 6 月—2015 年 5 月收治且符合选择标准的 32 例胸锁关节骨折脱位患者随机分为两组(n=16),分别采用新型解剖锁定钢板( A 组)和桡骨远端斜 T 型锁定钢板( B 组)内固定。两组患者性别、年龄、受伤侧别、体质量指数、致伤原因、受伤类型、伤后至手术时间及术前 Rockwood 评分等一般资料比较,差异均无统计学意义(P>0.05)。记录两组手术时间、术中失血量、切口长度、住院时间及术后并发症发生情况,采用 Rockwood 评分评定术后疗效。结果两组手术均顺利完成。A 组手术时间、术中失血量及住院时间均显著少于 B 组(P<0.05),但两组切口长度比较差异无统计学意义(t=0.672,P=0.507)。两组患者均获随访,随访时间 18~30 个月,平均 24 个月。A 组发生胸锁关节疼痛 1 例,切口感染 2 例;B 组发生胸锁关节疼痛 1 例,内固定松动 1 例,胸锁关节再次脱位 1 例;两组并发症发生情况比较差异无统计学意义(P=1.000)。两组患者术后各时间点 Rockwood 评分均较术前明显改善。术后 1 个月,A 组 Rockwood 评分显著高于 B 组(t=2.270,P=0.031),术后 6 个月及末次随访时两组 Rockwood 评分比较差异无统计学意义(P>0.05)。末次随访时根据 Rockwood 评分标准,A 组获优 13 例,良 2 例,可 1 例,优良率 93.75%;B 组获优 11 例,良 4 例,可 1 例,优良率 93.75%;两组比较差异无统计学意义(Z=–0.748,P=0.455)。结论新型胸锁关节解剖锁定钢板符合国人解剖特点,术中操作简便,且手术创伤小、手术时间短、术中失血量少、住院时间短,治疗胸锁关节骨折脱位可获较好疗效。

ObjectiveTo report a new type of anatomical locking plate for sternocalvicular joint, and investigate its effectiveness in treatment of sternoclavicular joint fracture and dislocation.MethodsA new type of anatomical locking plate for sternoclavicular joint was developed, which accorded with the anatomical features and biomechanical characteristics of Chinese sternoclavicular joint. By adopting the method of clinical randomized controlled study, 32 patients with the sternoclavicular joint fracture and dislocation who met the selection criteria between June 2008 and May 2015 were randomly divided into groups A and B (n=16), and the patients were treated with new anatomic locking plate and distal radial T locking plate internal fixation, respectively. There was no significant difference between 2 groups in gender, age, injured side, body mass index, cause of injury, type of injury, the time from injury to operation, and preoperative Rockwood grading score (P>0.05). The operation time, intraoperative blood loss, incision length, hospitalization time, and postoperative complications in 2 groups were recorded, and the effectiveness was evaluated by Rockwood grading score.ResultsThe operations of 2 groups completed successfully. The operation time, intraoperative blood loss, and hospitalization time in group A were significantly less than those in group B (P<0.05), but there was no significant difference in the incision length between 2 groups (t=0.672, P=0.507). All the patients were followed up 18-30 months (mean, 24 months). In group A, there were 1 case of sternoclavicular joint pain and 2 cases of wound infection; in group B, there were 1 case of sternoclavicular joint pain, 1 case of internal fixation loosening, and 1 case of sternoclavicular joint re-dislocation; there was no significant difference in complication incidence between 2 groups (P=1.000). The Rockwood grading scores at each time point after operation in 2 groups were significantly higher than those before operation. At 1 month after operation, the Rockwood grading score in group A was significantly higher than that in group B (t=2.270, P=0.031); but there was no significant difference in the Rockwood grading scores between the 2 groups at 6 months and at last follow-up (P>0.05). At last follow-up, according to the Rockwood scoring standard, the results of group A were excellent in 13 cases, good in 2 cases, poor in 1 case, the excellent and good rate was 93.75%; the results of group B were excellent in 11 cases, good in 4 cases, poor in 1 case, and the excellent and good rate was 93.75%; there was no significant difference between 2 groups (Z=–0.748, P=0.455).ConclusionThe new type of anatomic locking plate accords with the Chinese anatomical characteristics. It has the advantages of easy operative procedure, less surgical trauma, shorter operation time, less intraoperative blood loss, shorter hospitalization time, and it can achieve better results in the treatment of sternoclavicular joint fracture and dislocation.

关键词: 胸锁关节骨折脱位; 新型解剖锁定钢板; 内固定

Key words: Sternoclavicular joint fracture and dislocation; new type of anatomical locking plate; internal fixation

引用本文: 孙远林, 阳运康, 葛建华, 杨琨, 向飞帆, 周举, 梁杰. 新型胸锁关节解剖锁定钢板的研制与临床应用. 中国修复重建外科杂志, 2018, 32(3): 316-321. doi: 10.7507/1002-1892.201707081 复制