Department of Orthopedics, Feicheng Traditional Chinese Medicine Hospital, No.24 Changshan Street, Feicheng, Tai'an, 271600, Shandong Province, China.
Langenbecks Arch Surg. 2024 Nov 6;409(1):335. doi: 10.1007/s00423-024-03495-6.
Nice knots have been used as an assisted reduction technique in surgery for displaced and comminuted fractures. This study aims to investigate the clinical efficacy of Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures.
A retrospective study selected 210 patients with comminuted displaced clavicle fractures (January 2017-December 2020) in our hospital. The patients were divided into two groups via the fracture reduction method: the observation group (intramedullary Kirschner's wire fixation combined with modified Nice node-to-end cerclage temporarily fixation-assisted reduction; n = 42) and the control group (including four subgroups with 42 cases in each subgroup, with assisted reduction methods of clamp fixation, screw fixation, square knot fixation and Kirschner wire fixation; each subgroup n = 42). The operation time, intraoperative bleeding, visual analogue scale (VAS) score at 24 h after the operation, healing time, postoperative limb functional activities, patients' self-perception, subjective satisfaction and shoulder joint function were compared.
The operation time and the intraoperative blood loss of the observation group was significantly lower than that of each subgroup in the control group (p < 0.05). The VAS score of the observation group 24 h after the operation was significantly lower than that of each subgroup in the control group apart from the screw fixation group (p < 0.05). The Neer score of the observation group was significantly higher than that of each subgroup in the control group apart from the square knot fixation group (p < 0.05). The square knot is relatively better than the other four methods. Patients were generally satisfied with the modified Nice treatment.
The use of a Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures can achieve satisfactory postoperative clinical results.
纽结（Nice knot）已被用于手术中，辅助复位移位和粉碎性骨折。本研究旨在探讨克氏针髓内固定联合改良纽结线端环扎术临时固定辅助复位，在钢板接骨术治疗移位和粉碎性锁骨骨折前的临床疗效。
回顾性研究选取我院 2017 年 1 月至 2020 年 12 月收治的 210 例粉碎性移位锁骨骨折患者。根据骨折复位方法将患者分为两组：观察组（克氏针髓内固定联合改良纽结线端环扎术临时固定辅助复位；n=42）和对照组（包括夹固定、螺钉固定、方结固定和克氏针固定 4 种辅助复位方法，每组 42 例）。比较两组患者的手术时间、术中出血量、术后 24 小时视觉模拟评分（VAS）、愈合时间、术后肢体功能活动、患者自我感知、主观满意度和肩关节功能。
观察组手术时间和术中出血量明显低于对照组各亚组（p<0.05）。观察组术后 24 小时 VAS 评分明显低于对照组除螺钉固定组外的各亚组（p<0.05）。观察组 Neer 评分明显高于对照组除方结固定组外的各亚组（p<0.05）。方结与其他 4 种方法相比相对较好。患者对改良纽结的治疗普遍满意。
在钢板接骨术治疗移位和粉碎性锁骨骨折前，采用克氏针髓内固定联合改良纽结线端环扎术临时固定辅助复位，可获得满意的术后临床效果。
