摘要
【目的】探讨胸腔镜辅助复位经皮髓内钉内固定治疗锁骨中段骨折的临床价值。【方法】回顾性分析本院诊治的51例锁骨中段骨折患者,根据手术方法不同分为对照组和观察组,对照组患者33例,行传统手法复位经皮髓内钉内固定治疗;观察组18例,行胸腔镜辅助复位经皮髓内钉内固定治疗。比较两组患者手术时间、术中出血量、术后当天视觉模拟疼痛评分(VAS)及骨折愈合时间,术后6个月采用Constam-Murley评分量表评估两组患者临床疗效,并记录两组患者随访期间并发症发生情况。【结果】对照组4例术中复位困难,临时改切开复位术。观察组手术时间长于对照组(P<0.05),但两组患者术中出血量、术后当天VAS评分及骨折愈合时间比较差异均无统计学意义(均P>0.05)。术后6个月,两组患者功能活动、疼痛、肩关节活动度及肌力评分均较术前显著提高(均P<0.05),但两组患者各指标评分比较差异无统计学意义(P>0.05)。两组患者术后均获得随访,随访时间6〜18(11.67±3.12)个月,所有患者均获得解剖复位,均为Ⅰ期愈合。随访期间,对照组1例(3.45%)患者出现髓内钉取出困难,经沟通后成功取出髓内钉,1例(3.45%)患者出现骨折不愈合,于术后9个月采用锁定钢板翻修后骨折成功愈合;两组其余患者在随访期间均未发生髓内钉断裂、骨折不愈合等并发症,且均达到骨性愈合。【结论】尽管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,避免了辐射暴露,且临床疗效与传统手法复位经皮髓内钉内固定治疗相当,值得临床推广应用。
【Objective】To investigate the clinical value of thoracoscopic reduction and percutaneous intramedul-lary nailing fixation in the treatment of middle clavicular fracture.【Methods】A total of 51 patients with middle clavicle fracture were retrospectively analyzed.According to different surgical methods»they were divided into the control group and the observation group.Patients in the control group(n=33)were treated with traditional manual reduction and percutaneous intramedullary nailing fixation,while 18 patients in the observation group were treated with thoracoscopic-assisted reduction and percutaneous intramedullary nailing fixation.The operation time,intraoperative blood loss,VAS score and fracture healing time of the two groups were compared.The clinical efficacy of the two groups was evaluated by constant Murley score 6 months after operation,and the complications of the two groups during the follow-up period were recorded.【Resuhs】In the control group,4 cases were difficult to reduce during the operation,thus they were temporarily changed to open reduction.Patients in both groups were followed up for 6-18 months,with an average follow-up time of(11.67±3.12)months.The operation time of the observation group was longer than that of the control group(P<0.05).There was no significant difference in the amount of blood loss,VAS score on the day after surgery,and fracture healing time between the two groups(all P>0.05).However,6 months after surgery,the functional activity,pain,shoulder joint mobility and the scores of muscle strength in the two groups of patients were higher than those before operation(all P<0.05),but there was no statistically significant difference in the scores of the two groups of patients(P>0.05).Follow-up results showed that all patients received anatomical reduction and were healed by first intention.In the control group,1 case(3.45%)had difficulty in removing intramedullary nail and 1 case(3.45%)had fracture nonunion,whose fracture was successfully healed after 9 months postoperatively with a locking plate revision.The rest of the patients in the two groups had no complications such as intramedullary nail breakage or fracture nonunion during the follow-up period,and all achieved bony union.【Conclusion】Although thoracoscopic-assisted reduction and intramedullary nailing internal fixation for the treatment of mid clavicle fracture has a long operation time,no fluoroscopy is needed during the operation,so radiation exposure is avoided;and the clinical effect is equivalent to that of traditional manual reduction and percutaneous intramedullary nail internal fixation.
作者
彭党兵
陈塍林
PENG Dang-bing;CHEN Cheng-lin(Ring Pelvic Area,Xi'an Honghui Hospital Xi'an Shaanxi,710000)
出处
《医学临床研究》
CAS
2021年第5期673-676,共4页
Journal of Clinical Research
基金
陕西省重点研发计划项目(编号:2017ZDXM-SF-009)。
