The Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Jiaotong University, 600 Yishan Rd., Shanghai, China.
Can J Surg. 2010 Dec;53(6):379-84.
Midclavicular fractures are common clinically, accounting for about 76% of all clavicular fractures. Recent studies have revealed a previously unrecognized incidence of nonunion and malunion after conservative treatment of more severe midclavicular fractures. Our aim was to evaluate the clinical outcomes of midclavicular fractures treated with titanium elastic nails.
From February 2005 to February 2007, 41 patients with displaced midclavicular fractures received open reduction and internal fixation with a titanium elastic nail inserted through the sternal end of the clavicle. We evaluated the visual analogue scale (VAS), the Constant score and the Disabilities of the Arm, Shoulder and Hand (DASH) scale to determine outcomes.
A mean follow-up of 14.5 months (range 7-24 mo) revealed radiographic fracture union in all patients with an average clinical healing time of 2.2 months. Mean subjective pain 3 days after surgery was significantly lower than the day before surgery (p < 0.001). The mean range of motion 3 days after surgery was significantly improved compared with the day before surgery (p < 0.001). The nails were removed in all patients a mean of 7.2 months (range 5.4-9.5 mo) after surgery, and no fractures recurred. The mean postoperative DASH score was 2.5 (range 0.5-8.0) and the mean postoperative Constant score was 95.2 (range 86.5-97.0).
Limited open reduction and internal fixation with titanium elastic nails is a safe and minimally invasive surgical procedure for the treatment of displaced midclavicular fractures in adults and achieves good functional results and high patient satisfaction.
临床上常见的是锁骨中段骨折，约占锁骨骨折的 76%。最近的研究揭示了在保守治疗更严重的锁骨中段骨折后，先前未被认识到的不愈合和畸形愈合的发生率。我们的目的是评估钛弹性钉治疗锁骨中段骨折的临床结果。
2005 年 2 月至 2007 年 2 月，41 例移位性锁骨中段骨折患者采用切开复位钛弹性钉经胸骨端固定治疗。我们评估了视觉模拟评分（VAS）、Constant 评分和上肢功能障碍（DASH）评分来确定结果。
平均随访 14.5 个月（7-24 个月），所有患者均有影像学骨折愈合，平均临床愈合时间为 2.2 个月。术后 3 天的平均主观疼痛明显低于术前（p<0.001）。术后 3 天的平均关节活动度明显优于术前（p<0.001）。所有患者均在术后平均 7.2 个月（5.4-9.5 个月）取出内固定，无骨折再发。术后平均 DASH 评分为 2.5（0.5-8.0），术后平均 Constant 评分为 95.2（86.5-97.0）。
钛弹性钉有限切开复位内固定是治疗成人移位性锁骨中段骨折的一种安全、微创的手术方法，可获得良好的功能结果和患者满意度。
