School of Chinese Integrated Chinese and Western Medicines, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Orthopaedics Department, The Fourth Central Hospital Affiliated to Nankai University, Tianjin, China.
Orthop Surg. 2021 Oct;13(7):2111-2118. doi: 10.1111/os.13129. Epub 2021 Oct 4.
To compare the effectiveness of threaded elastic intramedullary nail and elastic locking intradullary nail (ELIN) for mid-shaft clavicular fractures.
The clinical data of 47 patients with middle clavicle fracture treated by TEIN and ELIN from August 2017 to March 2019 were analyzed retrospectively. Twenty-three patients received intramedullary fixation treatment with ELIN, nine males and 14 females, AO/OTA fracture classification type 2A (n = 17) and 2B (n = 6). Twenty-four patients received intramedullary fixation treatment with TEIN, including nine males and 15 females, AO/OTA classification: type 2A (n = 18) and 2B (n = 6). All patients were anesthetized with ipsilateral cervical plexus block. After internal fixation was removed, the clinical outcomes were assessed and evaluated. The Constant-Murley score and disabilities of the arm, shoulder and hand questionnaire (DASH) score were compared between the two groups to evaluate the functional status of all patients. The study was done accordingly to the guidelines provided by the ethics committee.
All patients in the two groups completed the operation successfully and were followed up. In the ELIN group, the operation time was 20.78 ± 7.71 min, intra-operative blood loss was 13.26 ± 9.72 mL, incision length was 1.60 ± 0.92 cm, internal fixation removal time was 12.86 ± 2.24 weeks, Constant-Murley score was 99.30 ± 1.36 points and DASH score was 1.43 ± 3.00 points. In the TEIN group, the operation time, intra-operative blood loss, incision length, internal fixation removal time, Constant-Murley and DASH scores were 22.83 ± 8.17 min, 22.08 ± 11.22 mL, 2.48 ± 0.84 cm, 15.66 ± 5.58 weeks, 95.79 ± 7.38 point and 6.69 ± 11.55 point respectively. In the ELIN group, four cases developed skin irritation, and the symptoms were relieved after removal of internal fixation. In the TEIN group, one patient's internal fixation broke and had an obvious scar at the incision, but there was no fracture after replacement of internal fixation; withdrawal of TEIN occurred in four patients, the nail did not shift again until the last follow-up; skin irritation and temporary bursitis occurred in six patients, and the symptoms were relieved after internal fixation was removed. No other conditions were found in the patients, and bony healing was achieved in all patients.
ELIN prevents shortening and malunion of the clavicle, reduces secondary damage to related tissues, and leads to restoration of clavicle length and faster osseous healing.
比较带螺纹弹性髓内钉和弹性锁定髓内钉(ELIN)治疗锁骨中段骨折的疗效。
回顾性分析 2017 年 8 月至 2019 年 3 月采用 ELIN 和 TEIN 治疗的 47 例锁骨中段骨折患者的临床资料。23 例行 ELIN 髓内固定治疗,男性 9 例,女性 14 例;AO/OTA 骨折分型 2A 型(n=17)和 2B 型(n=6)。24 例行 TEIN 髓内固定治疗,男性 9 例,女性 15 例;AO/OTA 分型:2A 型(n=18)和 2B 型(n=6)。所有患者均采用同侧颈丛阻滞麻醉。内固定取出后,评估并评价临床疗效。比较两组患者的 Constant-Murley 评分和上肢残疾问卷(DASH)评分,评估所有患者的功能状况。本研究符合伦理委员会提供的指导原则。
两组患者均顺利完成手术并获得随访。ELIN 组手术时间为 20.78±7.71 min,术中出血量为 13.26±9.72 ml,切口长度为 1.60±0.92 cm,内固定取出时间为 12.86±2.24 周,Constant-Murley 评分为 99.30±1.36 分,DASH 评分为 1.43±3.00 分。TEIN 组手术时间、术中出血量、切口长度、内固定取出时间、Constant-Murley 和 DASH 评分分别为 22.83±8.17 min、22.08±11.22 ml、2.48±0.84 cm、15.66±5.58 周、95.79±7.38 分和 6.69±11.55 分。ELIN 组 4 例出现皮肤刺激症状,内固定取出后症状缓解。TEIN 组 1 例患者内固定断裂,切口处有明显瘢痕,但无骨折;更换内固定后,4 例患者发生 TEIN 退出,末次随访时未见再次移位;6 例患者出现皮肤刺激和暂时性滑囊炎,内固定取出后症状缓解。所有患者均未出现其他情况,所有患者均骨性愈合。
ELIN 可防止锁骨缩短和畸形愈合,减少对相关组织的二次损伤,促进锁骨长度恢复和更快的骨愈合。