鎖骨骨折三種治療方式的對比研究

【摘要】 目的 對比分析改良克氏針、普通克氏針及重建鋼板三種內固定治療鎖骨骨折的臨床療效。方法 將入選的173例鎖骨骨折患者隨機分為三組，A組50例，B組88例，C組35例。分別予改良克氏針、普通克氏針及重建鋼板三種內固定治療，觀察三組手術時間、住院時間、術后并發癥、臨床療效及醫療費用等。結果 術后全部隨訪5～20個月，平均11.5個月。三組平均手術時間、住院時間以及平均醫療費用比較均有顯著性差異（P＜0.01），其中B、A組少于C組，B組又少于A組（P＜0.05或0.01）；三組優良率比較無顯著性差異（P＞0.05），并發癥發生率的比較有顯著性差異（P＜0.01）， A、C組低于B組（P＜0.05或0.01），C組與A組無顯著性差異（P＞0.05）。綜合判斷，A組的總體療效更好。結論 采用改良克氏針外鎖定髓內固定治療鎖骨骨折能以較小的醫療費用取得理想的臨床效果，相比普通克氏針和重建鋼板更加價廉高效，尤其適用于基層醫院。

【關鍵詞】 鎖骨骨折；內固定術；改良克氏針

文章編號：1003-1383(2010)02-0123-03 中圖分類號：R 681.7 文獻標識碼：A

doi:10.3969/j.issn.1003-1383.2010.02.003

Comparison of three modes in treatment of clavicular fracture

ZHANG Yonghua1，AI Changmiao1，LIShufei1，LIZhiyong2

(1.Fugang People's Hospital，Fugnag，Guangdong，511600；2.The First Affiliated Hospital of Sun

yatsen University，Guangzhou，Guangdong 510080)

【Abstract】 Objective To compare and analyze the clinical efficacy of improved Kirschner wire，common Kirschner wire and reconstraction plate as internal fixation modes in treatment of clavicular fracture.

Methods Retrospective analysis was performed in 173 patients who were diagnosed with clavicular fracture and treated by surgery during Jan，2003 to March，2009.Comperation of treee group in the aspect ofoperation time， hospitalization time，postoperative complications，clinical efficacy and health care cost were done.Results Cure rate of clinical efficacy in three treatment modes is no significant whereas the postoperative complications are more common in common Kirschner wire group compared with those of other groups. Reconstruction plate group has longer operation and hospitalization time as well as higher health care cost compared with those of rest two groups. The significance is reached.Con

clusion Using outside lock kirschner wire with hole for intramedullry fixation to treat clavicular fracture can obtain the good clinical efficacy and reduce the clinical cost compared with common kirschner wire and reconstraction plate，especially suitable in primary level hospital.

【Key words】 clavicular fracture；intramedullary fixation；improved kirschner wire

鎖骨骨折是臨床上常見的骨折，損傷機制多為肩部的直接暴力所致。絕大多數為中、外段骨折，內段骨折僅占約3%［1］。其內固定方式較多，各有優劣。本研究將2003年1月～2009年3月我院分別采用改良克氏針、普通克氏針及重建鋼板三種內固定手術方式治療鎖骨骨折共173例患者的療效進行對比分析，旨在探討更好的手術治療方式。

資料與方法

1.一般資料 本組173例，男118例，女55例；年齡12～75歲，平均37.5歲。受傷原因：摔傷39例，車禍傷96例，高處墜落傷17例，重物砸傷8例，打傷13例。骨折部位：中段及中外1/3交界處136例，外段37例。……