Xu Hong-Wei, He Xiao-Jun, Zhang Zhong-Wei, Chen Gang
Department of Orthopaedics, No.2 Affiliated Hospital of Jiaxing University, Jiaxing, 314001, Zhejiang, China.
Department of Orthopaedics, No.2 Affiliated Hospital of Jiaxing University, Jiaxing, 314001, Zhejiang, China;
Zhongguo Gu Shang. 2017 Oct 25;30(10):940-945. doi: 10.3969/j.issn.1003-0034.2017.10.012.
To evaluate the outcome of Titanium Elastic intramedullary nailing(TEN) for the treatment of refracture of clavicle.
From March 2010 to March 2016, 9 cases of clavicle fracture, postoperative re-fracture (plate broken before fracture healing, plate and screw pull out or refracture after fracture union and internal fixation removal) included 6 males and 3 females with a mean age of 38.6 years old ranging from 20 to 62 years old; 3 cases were sports injury, 5 cases were traffic injury, 1 case was severe injury. All cases were closed fractures, and 2 cases were multiple fractures. According to OTA(Orthopaedic Trauma Association classification), 2 cases were 06-A1, 1 case was 06-A2, 1 case was 06-A3, 2 cases were 06-B1, 2 cases were 06-B2, and 1 case was 06-B3. Among them, 4 cases were treated with AO titanium elastic intramedullary nail (TEN), and 5 cases of early internal fixation failure of clavicle fracture were treated with plate and screw internal fixation plus bone graft. The time of bone union, VAS score and Constant Shoulder Score were observed and recorded.
All incisions healed at stage I without infection. All 9 patients were followed up for a period of 14 months. All patients' implants were removed at 12 months after the second operation without refractures. The Constant score of shoulder joint was from 64 to 94 at 4 weeks after the second operation, 91 to 100 at 4 weeks after implants removal. The average bone healing time was 4.3 months from 3 to 6 months. The pain VAS score decreased significantly and the pain was relieved significantly.
Titanium elastic intramedullary nail (TEN) for the treatment of clavicle fracture after internal fixation of refracture patients can be achieved better outcomes, less trauma, good fracture healing, good postoperative recovery of shoulder joint function, but need to pay attention to the reasonable selection of patients.
评估钛弹性髓内钉（TEN）治疗锁骨再骨折的疗效。
2010年3月至2016年3月，9例锁骨骨折术后再骨折（骨折愈合前钢板断裂、钢板及螺钉拔出或骨折愈合且内固定取出后再骨折）患者，男6例，女3例，平均年龄38.6岁，年龄范围20至62岁；3例为运动损伤，5例为交通伤，1例为重伤。所有病例均为闭合性骨折，2例为多发性骨折。根据OTA（骨科创伤协会分类），2例为06 - A1型，1例为06 - A2型，1例为06 - A3型，2例为06 - B1型，2例为06 - B2型，1例为06 - B3型。其中4例采用AO钛弹性髓内钉（TEN）治疗，5例锁骨骨折早期内固定失败患者采用钢板螺钉内固定加植骨治疗。观察并记录骨愈合时间、视觉模拟评分（VAS）及肩关节Constant评分。
所有切口均一期愈合，无感染。9例患者均获随访14个月。所有患者均于二次手术后12个月取出内固定物，无再骨折发生。二次手术后4周肩关节Constant评分64至94分，取出内固定物后4周91至100分。平均骨愈合时间3至6个月，平均为4.3个月。疼痛VAS评分显著降低，疼痛明显缓解。
钛弹性髓内钉（TEN）治疗锁骨骨折内固定失败后的再骨折患者可取得较好疗效，创伤小，骨折愈合良好，术后肩关节功能恢复佳，但需注意患者的合理选择。
