Xu Hong-wei, Hu Jun-yu, Jia Shao-hua, Zhang Zhong-wei, Gong Sui-liang
Zhongguo Gu Shang. 2015 Feb;28(2):106-11.
To evaluate the outcome of Titanium elastic intramedullary nailing (TEN) for the treatment of displaced midclavicular fractures.
Between February 2010 and February 2013, 62 patients with displaced midclavicular fractures were treated by TEN, including 27 males and 35 females with an average age of 37.6 years old ranging from 15 to 67 years. The course of disease was from 1 to 9 days (means 2.7 days). Thirty-nine cases were treated by closed reduction and 23 cases by assistant small incision. Based on OTA (the Orthopaedic Trauma Association classification) classification, 31 cases of simple fractures involved 5 cases of 06-A1,15 cases of 06-A2,11 cases of 06-A3; 31 cases of wedge fractures involved 4 cases of 06-B1,12 cases of 06-B2,15 cases of 06-B3. Postoperative pain relief were evaluated by VAS score,and operation time,fracture healing time were recorded. After 6 weeks and after removing internal fixation shoulder joint function was evaluated by Constant score, and shoulder joint function were assessed by Herscovici score after 6 weeks.
Except 2 cases were lost to follow-up, 2 cases did not remove internal fixation, 3 cases' fractures were nonunion, the remaining 55 patients received follow-up for an average time of 11.4 months. The average preoperative VAS score was 5.20±0.71, and it turned to be 1.550.59 at 3 days after operation. The average operative duration was 40 min (15 to 65 min). The average bone healing time was (2.71±0.54) months (2 to 5 months). No difference about bone healing time was found between simple fractures and wedge fractures,and between the patients treated by closed reduction and assistant small incision. According to Herscovici standard, the shoulder function was excellent in 49 cases, good in 4, fair in 1, and poor in 1. Simple fractures achieved better Constant score than wedge fractures at 6 weeks postoperatively, whereas no difference was found at 4 weeks after fixation removal.
Titanium elastic nails (TEN) for treatment of displaced midclavicular fractures has advantages of good clinical effect,rapid pain relief,fast recovery of shoulder joint function. For OTA classification type B patients with comminuted fracture can replace steel to achieve very good effect, but to grasp the appropriate.
评估钛弹性髓内钉（TEN）治疗移位性锁骨中段骨折的疗效。
2010年2月至2013年2月，62例移位性锁骨中段骨折患者接受TEN治疗，其中男性27例，女性35例，平均年龄37.6岁（15至67岁）。病程1至9天（平均2.7天）。39例采用闭合复位，23例采用辅助小切口。根据OTA（骨科创伤协会分类）分类，31例简单骨折中，06-A1型5例，06-A2型15例，06-A3型11例；31例楔形骨折中，06-B1型4例，06-B2型12例，06-B3型15例。术后采用视觉模拟评分法（VAS）评估疼痛缓解情况，记录手术时间、骨折愈合时间。术后6周及取出内固定后，采用Constant评分评估肩关节功能，术后6周采用Herscovici评分评估肩关节功能。
除2例失访、2例未取出内固定、3例骨折不愈合外，其余55例患者平均随访11.4个月。术前VAS平均评分为5.20±0.71，术后3天降至1.55±0.59。平均手术时间为40分钟（15至65分钟）。平均骨折愈合时间为（2.71±0.54）个月（2至5个月）。简单骨折与楔形骨折之间、闭合复位与辅助小切口治疗患者之间的骨折愈合时间无差异。根据Herscovici标准，肩关节功能优49例，良4例，可1例，差1例。术后6周简单骨折的Constant评分优于楔形骨折，而取出内固定后4周无差异。
钛弹性髓内钉（TEN）治疗移位性锁骨中段骨折具有临床效果好、疼痛缓解快、肩关节功能恢复快等优点。对于OTA分类B型粉碎性骨折患者可替代钢板取得很好的效果，但要把握合适时机。
