中国修复重建外科杂志

中国修复重建外科杂志

胸腔镜辅助复位与传统手法复位经皮髓内钉内固定治疗锁骨中段骨折的疗效比较

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目的比较胸腔镜辅助复位与传统手法复位经皮髓内钉内固定治疗锁骨中段骨折的临床疗效。方法采用前瞻性临床随机对照研究,将 2012 年 3 月—2017 年 3 月收治且符合选择标准的 22 例锁骨中段骨折患者,按照随机数字表法分为试验组(7 例,胸腔镜辅助复位经皮髓内钉内固定)和对照组(15 例,传统手法复位经皮髓内钉内固定)。两组患者性别、年龄、致伤原因、骨折侧别、骨折分型、受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者手术时间、骨折愈合时间;术后 6 个月采用 Constant-Murley 评分量表进行疗效评价,分为主观评价指标(功能活动以及疼痛)及客观评价指标(肩关节活动度和肌力)。结果试验组手术时间显著长于对照组(t=5.881,P=0.000)。两组患者均获随访,随访时间 7~20 个月,平均 11 个月。骨折均获解剖复位,术后切口均 Ⅰ 期愈合。对照组 1 例髓内钉取出困难,1 例骨折不愈合;两组其余患者均未发生骨折不愈合、髓内钉断裂等并发症。两组骨折愈合时间比较差异无统计学意义(t=0.764,P=0.453)。术后 6 个月两组 Constant-Murley 评分各项指标比较,差异均无统计学意义(P>0.05)。结论胸腔镜辅助复位髓内钉内固定治疗锁骨中段骨折手术时间较长,但术中无需透视,临床疗效与传统手法复位手术相当。

ObjectiveTo compare the effectiveness of thoracoscopic assisted reduction and traditional manual reduction with percutaneous intramedullary nail internal fixation in the treatment of mid-clavicular fractures.MethodsA prospective randomized controlled trial was conducted. Twenty-two patients with mid-clavicular fractures who met the selection criteria between March 2012 and March 2017 were recruited and randomly divided into trial group (7 cases, thoracoscopic assisted reduction and percutaneous intramedullary nail fixation) and control group (15 cases, traditional manual reduction and percutaneous intramedullary nail fixation). There was no significant difference in gender, age, side, cause of injury, fracture classification, interval between injury and operation between the two groups (P>0.05). The operation time and fracture healing time were recorded and compared between the two groups. The effectiveness was evaluated by Constant-Murley scale at 6 months after operation, which included subjective evaluation indexes (functional activity and pain) and objective evaluation indexes (range of motion of shoulder joint and muscle strength).ResultsThe operation time of the trial group was significantly longer than that of the control group (t=5.881, P=0.000). Patients in both groups were followed up 7-20 months, with an average of 11 months. Satisfactory anatomical reduction achieved in all patients, and all incisions healed by first intension. In the control group, 1 patient had difficulty in removing the intramedullary nail, and 1 patient had fracture nonunion. No fracture nonunion or intramedullary nail rupture in the other patients of two groups. There was no significant difference in fracture healing time between the two groups (t=0.764, P=0.453). At 6 months after operation, there was no significant difference in Constant-Murley scale between the two groups (P>0.05).ConclusionThe treatment of the mid-clavicular fracture by using thoracoscopic assisted reduction with intramedullary nail internal fixation requires longer operation time, but does not require fluoroscopy. The effectiveness is comparable to that of traditional surgery.

关键词: 锁骨中段骨折; 胸腔镜; 髓内钉; 内固定

Key words: Mid-clavicular fracture; thoracoscopy; intramedullary nail; internal fixation

引用本文: 方凯彬, 许双塔, 郑煜晖, 黄隆, 陈守勃, 吴世强, 王文怀. 胸腔镜辅助复位与传统手法复位经皮髓内钉内固定治疗锁骨中段骨折的疗效比较. 中国修复重建外科杂志, 2019, 33(3): 323-327. doi: 10.7507/1002-1892.201808141 复制

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