摘要目的 对比切开复位钢板内固定及非手术方法治疗成人锁骨中段1/3移位骨折的临床疗效。方法 回顾性分析我院创伤骨科2010年3月至2013年5月治疗的60例锁骨中段1/3移位的病例,30例行切开复位钢板内固定,30例行锁骨吊带固定治疗。非手术治疗组30例,男20例,女10例;年龄14~70岁,平均(43.73±4.28)岁。钢板固定组30例,男21例,女9例;年龄16~63岁,平均(36.53±4.01)岁。两组患者在人口学特征、受伤严重程度、受伤机制及骨折类型方面无差别。研究结果按照随访时间、骨折愈合时间、肩关节功能活动及术后患者对肩关节外形满意度进行评价。骨折愈合时间主要根据术后影像学来判定。肩关节功能活动主要根据Constant肩关节评分(constant shoulder score,CSS),臂、肩、手功能障碍(the disability of the arm shoulder and hand score,DASH)评分来评定。结果 两组患者均获随访,平均随访时间为(32±3.40)个月。对两组CSS及DASH评分结果进行比较,均P<0.05(P=0.000,P=0.003),且钢板固定组均值均大于非手术组(均值差分别为5.49、2.71)。治疗愈合时间:钢板固定组(12.10±2.60)周,非手术治疗组(15.78±2.23)周。并发症:钢板固定组1例骨折不愈合(3%),无畸形愈合;非手术治疗组3例骨折不愈合(10%),12例畸形愈合(40%)。需要二次手术取出钢板是钢板固定组主要并发症,取出率为60%。非手术治疗主要并发症是骨折畸形愈合(40%)。患者对肩关节外形满意度分别为93%和77%。结论 在成人锁骨中段1/3移位骨折的治疗方法中,切开复位钢板组总体疗效优于非手术治疗组。切开复位钢板固定组在提高患者肩关节功能活动、降低骨折不愈合及畸形愈合方面优于非手术治疗。因内置物刺激症状而取出内固定是钢板固定组主要的并发症。
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