Department of Orthopaedics and Traumatology, Helsinki University Central Hospital and University of Helsinki, Topeliuksenkatu 5, 00260 Helsinki, Finland.
J Bone Joint Surg Am. 2012 Sep 5;94(17):1546-53. doi: 10.2106/JBJS.J.01999.
Few randomized controlled trials have compared operative with nonoperative treatment of clavicular fractures.
Patients with displaced midshaft clavicular fractures were randomized either to nonoperative treatment with a sling or to operative treatment with a stainless steel 3.5-mm reconstruction plate. Outcome measures were the Constant shoulder score, DASH (Disabilities of the Arm, Shoulder and Hand) score, pain, fracture-healing, and complications. The null hypothesis was that the Constant and DASH scores would not differ between the groups at the one-year follow-up evaluation.
In accordance with the power analysis, we included sixty patients in the study; thirty-two were randomized to the nonoperative group and twenty-eight to the operative group. We found no difference in the Constant score (p = 0.75), the DASH score (p = 0.89), or pain (p = 0.98) between the groups at the one-year follow-up evaluation. All fractures in the operative group healed, but six nonunions (24%) occurred in the nonoperative group.
One year after a displaced midshaft clavicular fracture, nonoperative treatment resulted in a higher nonunion rate but similar function and disability compared with operative treatment.
比较锁骨骨折手术与非手术治疗的随机对照试验较少。
将移位的锁骨中段骨折患者随机分为非手术治疗（吊带固定）或手术治疗（不锈钢 3.5mm 重建板）。主要的结局评估指标是 Constant 肩关节评分、DASH（上肢功能障碍）评分、疼痛、骨折愈合情况和并发症。零假设是两组在一年随访时 Constant 和 DASH 评分无差异。
根据功效分析，我们纳入了 60 例患者，其中 32 例被随机分为非手术组，28 例被随机分为手术组。我们发现两组在一年随访时 Constant 评分（p=0.75）、DASH 评分（p=0.89）和疼痛评分（p=0.98）均无差异。手术组所有骨折均愈合，但非手术组有 6 例（24%）发生骨折不愈合。
对于移位的锁骨中段骨折，一年后非手术治疗的骨折不愈合发生率更高，但功能和残疾情况与手术治疗相似。
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