摘要
[目的]比较Tight-rope联合经皮螺钉与锁骨钩钢板治疗老年Cho IIC型锁骨远端骨折的临床疗效。[方法]回顾性分析2015年1月—2023年1月在本科接受手术治疗的老年Cho IIC型锁骨远端骨折63例患者的临床资料。根据医患沟通结果,31例采用Tight-rope联合经皮螺钉固定(袢钉组),32例采用锁骨钩钢板技术(钩板组)。比较两组围手术期、随访和影像资料。[结果]袢钉组手术时间[(65.8±16.7) min vs (83.1±20.8) min,P<0.001]、切口长度[(1.9±0.7) cm vs (9.5±1.9) cm,P<0.001]、术中出血量[(21.5±9.9) m L vs (97.5±55.8) mL,P<0.001]、住院时间[(8.4±2.2) d vs (13.3±5.6) d,P<0.001]均显著优于钩板组。所有患者均获得12个月以上随访。随时间推移,两组VAS评分、Constant-Murley评分及前屈上举ROM、外展上举ROM均显著改善(P<0.05)。术后3个月、末次随访时袢钉组的VAS评分[(1.7±0.6) vs (2.6±1.1),P<0.001;(0.6±0.5) vs (1.5±0.9),P<0.001]、ConstantMurley评分[(85.0±4.0) vs (80.0±4.6),P<0.001;(91.9±3.9) vs (88.5±4.8),P<0.001]及肩前屈上举ROM [(127.3±11.1)°vs (118.2±14.7)°,P=0.008;(155.3±10.9)°vs (144.7±13.5)°,P<0.001]、肩外展上举ROM [(116.5±10.0)°vs (108.1±12.9)°,P<0.001;(148.9±13.0)°vs(127.7±17.9)°,P<0.001]均优于钩板组。影像方面,两组骨折复位质量的差异无统计学意义(P>0.05)。两组术后喙锁距离(coracoclavicular distance,CC)均显著改善(P<0.05),相应时间点,两组CC的差异均无统计学意义(P>0.05)。[结论]两种手术方式治疗老年骨质疏松性Cho IIC型锁骨远端骨折均可获得良好临床疗效,其中经皮螺钉联合改良Tight-rope技术具有切口小、创伤少的特点,可以更好地改善术后早期疼痛,利于肩关节功能恢复。
[Objective] To compare the clinical efficacy of Tightrope combined with percutaneous screw(TRPS) versus clavicular hook plate(HP) for Cho's type IIC distal clavicular fracture in the elderly.[Methods] A retrospective study was conducted on 63 elderly who had Cho's IIC distal clavicle fractures treated surgically in our department from January 2015 to January 2023.According to the doctor-patient communication,31 patients were treated with TRPS,while other 32 patients received HP.The perioperative,follow-up and imaging data of the two groups were compared.[Results] The TRPS group proved significantly superior to the HP group in terms of operation time [(65.8±16.7 min) vs(83.1±20.8) min,P<0.001],incision length [(1.9±0.7) cm vs(9.5±1.9) cm,P<0.001],intraoperative blood loss [(21.5±9.9) mL vs(97.5±55.8) m L,P<0.001],and hospital stay [(8.4±2.2) days vs(13.3±5.6) days,P<0.001].All patients in both groups were followed for more than 12 months.As time went on,the VAS score,Constant-Murley score,forward elevation range of motion(ROM) and abduction elevation ROM were significantly improved in both groups(P<0.05).The TRPS group was significantly better than the HP group in terms VAS score[(1.7±0.6) vs(2.6±1.1),P<0.001;(0.6±0.5) vs(1.5±0.9),P<0.001],Constant-Murley score [(85.0±4.0) vs(80.0±4.6),P<0.001;(91.9±3.9) vs(88.5±4.8),P<0.001] and forward elevation ROM [(127.3±11.1)° vs(118.2±14.7)°,P=0.008;(155.3±10.9)° vs(144.7±13.5)°,P<0.001],abduction elevation ROM [(116.5±10.0)° vs(108.1±12.9)°,P<0.001;(148.9±13.0)° vs(127.7±17.9)°,P<0.001] 3 months postoperatively and the latest follow-up.As for imaging.there was no significant difference in fracture reduction quality between the two groups(P>0.05).The coracoclavicular distance(CC) was significantly decreased in both group after operation compared with that preoperatively(P<0.05),whereas which was not statistically significant between the two groups at any corresponding time points(P>0.05).[Conclusion] Both surgical techniques for the treatment of senile osteoporotic Cho's type IIC distal clavicle fracture have obtained good clinical consequence.However,the Tightrope combined with percutaneous screw takes advantages of small incision and less trauma,relieving early postoperative pain and facilitating the functional recovery over the hook plate.
作者
俞云飞
吴毛
殷铭
胡钢
顾鸿程
YU Yun-fei;WU Mao;YIN Ming;HU Gang;GU Hong-cheng(Department of Orthopedics and Traumatology,Wuxi Municipal Hospital of Traditional Chi-nese Medicine,Wuxi,Jiangsu 214000,China)
出处
《中国矫形外科杂志》
北大核心
2025年第8期681-687,共7页
Orthopedic Journal of China
基金
江苏省名老中医药专家传承工作室建设项目(编号:苏中医科教[2021]7号)
江苏省中医药科技发展计划项目(编号:MS2023065)
无锡市“双百”后备拔尖人才项目(编号:HB2020064)。
作者简介
俞云飞,副主任医师,研究方向:四肢创伤、脊柱关节的退变性疾病,电子信箱:18955385575@163.com;通信作者:胡钢,电话:0510-88859999,电子信箱:fantasyhg@163.com。
