Govindasamy Rajesh, Kasirajan Saravanan, Meleppuram Jimmy Joseph, Thonikadavath Fawas
Vinayaka Missions Medical College and Hospital, Department of Orthopaedics, Pondy, India.
Rev Bras Ortop. 2016 Dec 30;52(3):270-277. doi: 10.1016/j.rboe.2016.07.005. eCollection 2017 May-Jun.
The aim of this study is to analyze the functional outcome following titanium elastic stable intra-medullary nailing (ESIN) for displaced mid-shaft clavicular fractures (DMCF).
A retrospective study of 60 patients between March 2009 and March 2015 was conducted. Patients were selected based on the inclusion criteria. Six patients were lost during follow up. Out of the remaining 54 patients, there were 39 males and 15 females. The mean age was 30.6 years. The functional outcome was analyzed using the Constant score, rate of bone union, complication, and earliest time of return to work.
All fractures united well, with an average time of 7.5 weeks. Follow-up period ranged between 12 months and 18 months (average, 14 months). 24 out of 54 patients had closed nailing, while 30 had minimal open reduction. The average size of ESIN was 2 mm (range, 1.5-3 mm). The average Constant score was 97.8 (range, 95-99). There were no major complications, but minor complications occurred, viz. skin irritation in 15 patients, temporary paresthesia in five patients, and three patients who developed superficial infections. One case had implant migration and perforation at the lateral cortex, and one case had delayed union. There were few implant-related problems, as the authors used a standard protocol to remove it after radiological union. All patients returned to work within 10 weeks of the post-operative period.
ESIN is a safe, minimally invasive, engenders rapid healing with good cosmesis, and provides an excellent functional outcome in terms of patient satisfaction, with fewer complications.
本研究旨在分析采用钛制弹性髓内钉（ESIN）治疗移位型锁骨中段骨折（DMCF）后的功能结果。
对2009年3月至2015年3月期间的60例患者进行回顾性研究。根据纳入标准选择患者。6例患者在随访期间失访。在其余54例患者中，男性39例，女性15例。平均年龄为30.6岁。采用Constant评分、骨愈合率、并发症及最早复工时间对功能结果进行分析。
所有骨折均愈合良好，平均愈合时间为7.5周。随访期为12个月至18个月（平均14个月）。54例患者中24例行闭合穿钉，30例行微创切开复位。ESIN的平均直径为2mm（范围1.5 - 3mm）。平均Constant评分为97.8（范围95 - 99）。无重大并发症，但出现了轻微并发症，即15例患者出现皮肤刺激，5例患者出现短暂感觉异常，3例患者发生浅表感染。1例出现植入物向外侧皮质移位和穿孔，1例出现延迟愈合。由于作者采用标准方案在影像学显示骨折愈合后取出植入物，所以植入物相关问题较少。所有患者均在术后10周内恢复工作。
ESIN是一种安全、微创的方法，能促进快速愈合，美容效果好，患者满意度高，并发症少，功能结果优良。
