弹性髓内钉治疗青少年锁骨骨折的临床应用

摘要

Objecdve:Ta investigate the feasibility and clinical effects of titanium elastic nails (TEN) for adolescent clavicular fracture. Methods:From October 2008 to November 2009,17 adolescent patients with clavicular fracture were treated with internal fixation, including 11 males and 5 females who ranged in age from 12to 18years (mean 15.3 years). The mean time from injury to surgery was 3.5 days (2-7 days). Constant function score before surgery and that 3 months after surgery and Shoulder ROM before surgery and that 2 months after surgery were compared. Fracture reduction and healing were followed up by X-rays to analyze internal fixation with the TEN technique. Results: All patients were followed up for a mean of 6.5 months (range 3—8 months),during which no infection,TEN fracture or skin bursting was observed. The Constant score rose from preoperative (45.3±6.1) to (85.6±4.3) at 3-month follow up (1=22.164, P<0.01) ,and the shoulder activity degree at 2-week follow up was improved obviosly from preoperative (P<0.01). X-ray at 12-16 weeks after surgery showed good bone healing and recovery of shoulder function. Conclusion: Internal fixation with TEN in the treatment of adolescent clavicular fracture is safe,minimally invasive,reliable and cosmetic. This technique provides a liable ption far the treatment of adolescent clavicular fracture.%目的:探讨弹性髓内钉治疗青少年锁骨骨折的方法和临床疗效.方法:2008年10月至2009年11月,采用弹性髓内钉治疗17例青少年急性锁骨骨折,男11例,女6例；年龄12～18岁,平均15.3岁.伤后至手术时间2～7 d,平均3.5 d.对术前和术后3个月随访时的肩关节Constant评分、术前和术后2周肩关节活动度进行比较,并通过X线片检查观察患者骨折愈合及复位情况.结果:所有患者均获得随访,时间3～8个月,平均6.5个月.没有出现感染、TEN断裂及顶破皮肤等并发症.术后3个月Constant评分(85.6±4.3)分,较术前(45.3±6.1)分明显提高(t=22.164,P＜0.01).术后2周肩关节活动度较术前明显改善(P＜0.01).术后12～16周取出髓内钉X线片显示骨性愈合,肩关节活动度恢复良好.结论:弹性髓内钉治疗青少年锁骨骨折具有疗效良好,创伤小,固定可靠等优点,其为锁骨骨折青少年治疗提供一种可靠的选择.