摘要目的 比较闭合复位髓内钉与切开复位接骨板固定治疗锁骨中段骨折的疗效. 方法 采用随机数字表法将2012年7月至2014年5月期间手术治疗的194例(男136例,女58例;年龄16～65岁)锁骨中段骨折患者分为2组进行对照研究:行闭合复位髓内钉固定98例(髓内钉组),行切开复位接骨板固定96例(接骨板组).记录并比较两组患者的手术时间、术中出血量等.术后3、6、12个月时采用上肢功能评分表(DASH)和Constant-Murley评分评估患肢功能情况.两组患者术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性. 结果 194例患者术后获12 ～27个月随访,平均(15.6±3.1)个月.髓内钉组患者手术时间[(27.7±16.3)min]、术中出血量[(18.6±14.4)mL]、住院费用[(12 462.0±3 263.4)元]、骨折愈合时间[(12.1±3.O)周]优于接骨板组患者[(62.3±19.4)min、(40.3±17.4)mL、(24 760.0±3 320.4)元、(16.9±2.8)周],差异均有统计学意义(P＜0.05).术后3个月髓内钉组与接骨板组患者DASH评分分别为(24.8±6.7)、(13.4±3.5)分,Constant-Murley评分分别为(69.1±6.2)、(88.5±5.9)分,两组间比较差异有统计学意义(P＜0.05).术后6、12个月髓内钉组与接骨板组DASH评分和Constant-Murley评分比较差异均无统计学意义(P＞0.05).髓内钉组与接骨板组并发症发生率分别为25.5％ (25/98)、9.4％ (9/96),差异有统计学意义(P＜0.05). 结论 与切开复位接骨板相比,闭合复位髓内钉固定治疗锁骨中段骨折具有损伤小、花费低、骨折愈合快等优点,但并发症发生率较高;两种治疗方式对肩关节功能恢复疗效相当.

abstractsObjective To compare the clinical effects of closed reduction and intramedullary nailing versus open reduction and plate fixation in the treatment of displaced midshaft clavicular fractures.Methods A prospective,randomized,controlled trial was performed between July 2012 and May 2014 in 194 patients with acute displaced midshaft clavicular fracture.They were 136 males and 58 females,from 16 to 65 years of age.They were randomly divided into 2 groups to received either closed reduction and intramedullary nailing (n =98) or open reduction and plate fixation (n =96).We recorded operation time,intraoperative blood loss,hospitalization expenses,fracture healing time and complication rate.Functional assessments were conducted at 3,6 and 12 months using the Disabilities of the Arm,Shoulder and Hand (DASH) and Constant-Murley scores.The preoperative general data showed no statistical significance between the 2 groups (P ＞ O.05).Results All the 194 patients were followed up for 12 to 27 months (average,15.6 ±3.1 months).The operation time (27.7 ± 16.3 min),intraoperative blood loss (18.6 ± 14.4 mL),hospitalization expenses (12,462.0 ±3,263.4 yuan),and fracture healing time (12.1 ± 3.0 weeks) in the intramedullary nailing group were significantly better than those(62.3 ± 19.4 min,40.3 ± 17.4 mL,24,760.0 ± 3,320.4 yuan,and 16.9 ± 2.8 weeks) in the plate fixation group (P ＜ 0.05).At 3 months after surgery,the DASH (13.4 ± 3.5) and Constant-Murley (88.5 ±5.9) scores in the plate fixation group were significantly better than those (24.8 ± 6.7 and 69.1 ± 6.2,respectively) in the intramedullary nailing group (P ＜ 0.05).At 6 and 12 months after surgery,there were no significant differences in the Constant-Murley scores or DASH scores between the 2 groups (P ＞ 0.05).The complication rate in the intramedullary nailing group (25.5％,25/98) was significantly higher than in the plate fixation group (9.4％,9/96) (P ＜ 0.05).Conclusions In the treatment of displaced midshaft clavicular fractures,compared with open reduction and plate fixation,closed reduction and intramedullary nailing has advantages of less invasion,lower cost and faster fracture healing,but a disadvantage of higher complication rate.The 2 treatments may lead to similar functional recovery of the shoulder.