| 钛弹性髓内钉治疗锁骨干骨折的临床应用 |
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投稿时间：2014-07-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 徐红伟 |
XU Hong-wei |
嘉兴学院附属第二医院, 浙江 嘉兴 314001 |
Department of Orthopaedics, the No.2 Affiliated Hospital of Jiaxing University, Jiaxing 314001, Zhejiang, China |
13738261390@139.com |
| 胡隽宇 |
HU Jun-yu |
嘉兴学院附属第二医院, 浙江 嘉兴 314001 |
Department of Orthopaedics, the No.2 Affiliated Hospital of Jiaxing University, Jiaxing 314001, Zhejiang, China |
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| 贾少华 |
JIA Shao-hua |
嘉兴学院附属第二医院, 浙江 嘉兴 314001 |
Department of Orthopaedics, the No.2 Affiliated Hospital of Jiaxing University, Jiaxing 314001, Zhejiang, China |
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| 张中伟 |
ZHANG Zhong-wei |
嘉兴学院附属第二医院, 浙江 嘉兴 314001 |
Department of Orthopaedics, the No.2 Affiliated Hospital of Jiaxing University, Jiaxing 314001, Zhejiang, China |
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| 龚遂良 |
GONG Sui-liang |
嘉兴学院附属第二医院, 浙江 嘉兴 314001 |
Department of Orthopaedics, the No.2 Affiliated Hospital of Jiaxing University, Jiaxing 314001, Zhejiang, China |
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| 期刊信息：《中国骨伤》2015年，第28卷，第2期，第106-111页 |
| DOI：10.3969/j.issn.1003-0034.2015.02.003 |
| 基金项目: |
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中文摘要:
目的:探讨钛弹性髓内钉(TEN)替代钢板微创治疗锁骨干骨折的疗效.
方法:自2010年2月至2013年2月,采用弹性髓内钉微创治疗62例锁骨干骨折患者,男27例,女35例;年龄15～62岁,平均37.6岁;病程1～9 d,平均2.7 d.39例闭合复位内固定成功,23例需要在骨折端作约3 cm切口辅助复位内固定.根据OTA(Orthopaedic Trauma Association classification)分型,简单骨折有5例06-A1,15例06-A2,11例06-A3,楔形骨折有4例06-B1,12例06-B2,15例06-B3.观察患者术后疼痛缓解情况进行VAS评分,记录手术时间、骨折愈合时间.术后6周及去除内固定后行肩关节Constant评分,术后6周行肩关节Herscovici评分.
结果:除2例失访,2例未取内固定,3例骨折尚未愈合患者,其余55例患者获随访,平均随访时间11.4个月.患者术前患肩疼痛VAS评分5.20±0.71,术后第3天VAS评分1.55±0.59,疼痛缓解显着.手术时间15～65 min,平均40 min.骨折愈合时间2～5个月,平均(2.71±0.54)个月;简单骨折与楔形骨折、切开复位和闭合复位患者骨折愈合时间差异均无统计学意义.术后根据Herscovici标准评定患侧肩关节功能:优49例,良4例,可1例,差1例.肩关节Constant评分在术后6周简单骨折患者肩关节功能优于楔形骨折患者;在内固定取出后4周简单骨折和楔形骨折肩关节Constant评分无明星差异.
结论:钛弹性髓内钉(ETN)治疗有移位的锁骨干骨折患者临床效果良好,疼痛缓解迅速,术后肩关节功能恢复快.对于OTA分型B型的粉碎骨折患者也能替代钢板取得很好效果,但是要掌握合适的适应证. |
| 【关键词】锁骨 骨折 骨折固定术,髓内 外科手术,微创性 |
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| AO elastic intramedullary nailing for the treatment of clavicle fractures |
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ABSTRACT
Objective:To evaluate the outcome of Titanium elastic intramedullary nailing (TEN) for the treatment of displaced midclavicular fractures.
Methods:Between February 2010 and February 2013,62 patients with displaced midclavicular fractures were treated by TEN,including 27 males and 35 females with an average age of 37.6 years old ranging from 15 to 67 years. The course of disease was from 1 to 9 days (means 2.7 days). Thirty-nine cases were treated by closed reduction and 23 cases by assistant small incision. Based on OTA (the Orthopaedic Trauma Association classification) classification,31 cases of simple fractures involved 5 cases of 06-A1,15 cases of 06-A2,11 cases of 06-A3;31 cases of wedge fractures involved 4 cases of 06-B1,12 cases of 06-B2,15 cases of 06-B3. Postoperative pain relief were evaluated by VAS score,and operation time,fracture healing time were recorded. After 6 weeks and after removing internal fixation shoulder joint function was evaluated by Constant score,and shoulder joint function were assessed by Herscovici score after 6 weeks.
Results:Except 2 cases were lost to follow-up,2 cases did not remove internal fixation,3 cases' fractures were nonunion,the remaining 55 patients received follow-up for an average time of 11.4 months. The average preoperative VAS score was 5.20±0.71,and it turned to be 1.55±0.59 at 3 days after operation. The average operative duration was 40 min (15 to 65 min). The average bone healing time was (2.71±0.54) months (2 to 5 months). No difference about bone healing time was found between simple fractures and wedge fractures,and between the patients treated by closed reduction and assistant small incision. According to Herscovici standard,the shoulder function was excellent in 49 cases,good in 4,fair in 1,and poor in 1. Simple fractures achieved better Constant score than wedge fractures at 6 weeks postoperatively,whereas no difference was found at 4 weeks after fixation removal.
Conclusion:Titanium elastic nails (TEN) for treatment of displaced midclavicular fractures has advantages of good clinical effect,rapid pain relief,fast recovery of shoulder joint function. For OTA classification type B patients with comminuted fracture can replace steel to achieve very good effect,but to grasp the appropriate. |
| KEY WORDS Clavicle Fractures Fracture fixation,intramedullary Surgical procedures,minimally invasive |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 徐红伟,胡隽宇,贾少华,张中伟,龚遂良.钛弹性髓内钉治疗锁骨干骨折的临床应用[J].中国骨伤,2015,28(2):106~111 |
| 英文格式: | XU Hong-wei,HU Jun-yu,JIA Shao-hua,ZHANG Zhong-wei,GONG Sui-liang.AO elastic intramedullary nailing for the treatment of clavicle fractures[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(2):106~111 |
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