Jubel A, Andermahr J, Schiffer G, Rehm K E
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie der Universität Köln, Kerpener Str. 61, 50931 Köln.
Unfallchirurg. 2002 Jun;105(6):511-6. doi: 10.1007/s00113-001-0386-z.
This prospective controlled clinical trial was performed to assess fracture healing and clinical outcome after intramedullary nailing of midclavicular fractures. Within 3.5 years elastic-stable intramedullary nailing was performed in 62 patients with 65 midclavicular fractures. Surgery was performed in supine position. The ventral cortex of the proximal clavicle was opened using a 2.5 mm drill. The nail was advanced laterally under fluoroscopic control. If closed reduction failed, an additional incision was made to enable direct manipulation of the fragments. There were no infections, no implant displacements or refractures. Postoperatively, the mean subjective pain was significantly lower, and the range of motion improved. We observed one nonunion. The mean Constant-score 6 months after hardware removal was 96.9 +/- 3.3 points. Intramedullary fixation of midclavicular fractures with an elastic titanium nail is a safe minimally invasive surgical technique, producing excellent functional and cosmetic results.
本前瞻性对照临床试验旨在评估锁骨中段骨折髓内钉固定后的骨折愈合情况及临床疗效。在3.5年的时间里,对62例锁骨中段骨折患者进行了65次弹性稳定髓内钉固定术。手术在仰卧位进行。使用2.5毫米钻头打开锁骨近端的腹侧皮质。在透视控制下将髓内钉向外侧推进。如果闭合复位失败,则需额外做一个切口以便直接处理骨折碎片。未发生感染、植入物移位或再骨折。术后,平均主观疼痛明显减轻,活动范围有所改善。我们观察到1例骨不连。取出内固定装置6个月后的平均Constant评分是96.9±3.3分。采用弹性钛钉对锁骨中段骨折进行髓内固定是一种安全的微创手术技术,可产生优异的功能和美容效果。