| 锁骨中段骨折分型及可塑性夹板治疗的临床观察 |
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投稿时间：2021-08-13
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| 作者 | Author | 单位 | Address | E-Mail |
| 朱兴涛 |
ZHU Xing-tao |
南京中医药大学, 江苏 南京 210023 |
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| 孙轶韬 |
SUN Yi-tao |
南京中医药大学, 江苏 南京 210023 |
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| 孙一夫 |
SUN Yi-fu |
南京中医药大学, 江苏 南京 210023 |
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| 林顺 |
LIN Shun |
南京中医药大学, 江苏 南京 210023 |
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| 姜宏 |
JIANG Hong |
南京中医药大学附属苏州市中医医院, 江苏 苏州 215007 |
Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Suzhou 215007, Jiangsu, China |
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| 刘锦涛 |
LIU Jin-tao |
南京中医药大学附属苏州市中医医院, 江苏 苏州 215007 |
Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Suzhou 215007, Jiangsu, China |
okdoctor@163.com |
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| 期刊信息：《中国骨伤》2022年，第35卷，第3期，第258-264页 |
| DOI：10.12200/j.issn.1003-0034.2022.03.012 |
| 基金项目:第3批江苏省老中医药专家学术经验继承项目[编号:苏科教（2019）8号] |
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中文摘要:
目的: 根据73例保守治疗的锁骨中段骨折病例，提出一种锁骨中段骨折分型并观察可塑性夹板治疗该分型锁骨中段骨折患者的临床疗效。
方法: 回顾性分析2018年9月至2020年8月采用可塑性夹板治疗的73例锁骨中段骨折患者，根据骨折移位类型将73例患者分为4型。Ⅰ型16例，男7例，女9例；年龄18~37（28.6±7.8）岁；病情轻度12例，中度3例，重度1例。Ⅱ型16例，男6例，女10例；年龄25~49（37.3±9.4）岁；病情轻度5例，中度8例，重度3例。Ⅲ型7例，男4例，女3例；年龄33~57岁；病情轻度2例，中度3例，重度2例。Ⅳ型34例，男16例，女18例；年龄48~82（66.4±14.9）岁；病情轻度7例，中度17例，重度10例。所有患者接受可塑性夹板外固定治疗4周。观察记录治疗前及治疗1、3、9个月后的疼痛视觉模拟评分（visual analgue scale，VAS）评分及Constant-Murley肩关节评分以评估患者患肢治疗前后的疼痛程度变化情况和肩关节功能恢复情况。末次随访时记录患者对治疗后外观是否满意，根据末次随访时X线表现判断患者是否发生骨折不愈合，并根据骨折愈合时间及影像学表现综合得出不同分型患者临床疗效的优良率。
结果: 所有患者获得随访，时间9~11（9.8±0.7）个月。Ⅰ、Ⅱ、Ⅳ型治疗前VAS分别为（2.88±0.83）、（3.67±0.80）、（6.92±1.71）分，治疗9个月后分别降至（0.54±0.19）、（0.77±0.25）、（1.18±0.17）分。Ⅰ、Ⅱ、Ⅳ型Constant-Murley肩关节评分治疗前分别为（65.81±2.09）、（63.50±2.22）、（47.93±2.91）分，治疗9个月后分别升至（88.56±2.11）、（85.12±2.23）、（71.25±2.16）分。5例对治疗后的外观不满意；6例在治疗9个月后未见明显连续性骨痂通过，为骨折不愈合。
结论: 锁骨中段骨折分型与临床更为贴切，对锁骨中段骨折治疗方式的选择及预后有一定的临床指导意义。可塑性夹板治疗无明显移位及重叠移位的锁骨中段骨折近期临床疗效确切且并发症发生率较低，可以在临床中推广使用。 |
| 【关键词】锁骨 骨折 小夹板固定术 |
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| Clinical observation on plastic splint treatment of middle clavicle fracture based on a new classification |
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ABSTRACT
Objective: According to 73 patients with middle clavicle fracture treated conservatively,a new classification of middle clavicle fracture was proposed,and the clinical effect of plastic splint in the treatment of middle clavicle fracture was observed.
Methods: Total 73 patients with middle clavicle fracture treated with plastic splint from September 2018 to August 2020 were analyzed retrospectively. All the patients were divided into 4 types according to the degree of fracture displacement. There were 16 cases of typeⅠ,including 7 males and 9 females,ranging in age from 18 to 37 years old,with a mean of (28.6±7.8) years old;12 cases of mild disease,3 cases of moderate disease and 1 case of severe disease. There were 16 cases of type Ⅱ,including 6 males and 10 females,ranging in age from 25 to 49 years old,with a mean of (37.3±9.4) years old;5 cases of mild disease,8 cases of moderate disease and 3 cases of severe disease. There were 7 cases of type Ⅲ,including 4 males and 3 females,ranging in age from 33 to 57 years old;2 cases of mild disease,3 cases of moderate disease and 2 cases of severe disease. There were 34 cases of type Ⅳ,including 16 males and 18 females,ranging in age from 48 to 82 years old,with a mean of(66.4±14.9) years old;7 cases of mild disease,17 cases of moderate disease and 10 cases of severe disease. All patients received plastic splint external fixation for 4 weeks. Visual analgue scale (VAS) and Constant-Murley shoulder scores before treatment and 1,3 and 9 months after treatment were observed and recorded to evaluate the change of pain degree and shoulder function recovery before and after treatment. The patients' satisfaction with the appearance after treatment was recorded at the latest follow-up. The X-ray findings at the latest follow-up were used to judge whether the patient had fracture nonunion. And according to the fracture healing time and imaging findings,the excellent and good rate of clinical curative effect in patients with different types was obtained.
Results: All patients were followed up,and the duration ranged from 9 to 11 months,with a mean of (9.8±0.7) months. The VAS scores of typeⅠ,typeⅡand type Ⅳ before treatment were 2.88±0.83,3.67±0.80 and 6.92±1.71 respectively,which were decreased to 0.54±0.19,0.77±0.25 and 1.18±0.17 respectively after 9 months of treatment. The Constant-Murley shoulder scores of typeⅠ,typeⅡand type Ⅳ were 65.81±2.09,63.50±2.22 and 47.93±2.91 respectively before treatment,and increased to 88.56±2.11,85.12±2.23 and 71.25±2.16 respectively after 9 months of treatment. Five patients were not satisfied with the appearance after treatment;6 patients had no obvious continuous callus passing through after 9 months of treatment,which was fracture nonunion.
Conclusion: The classification of middle clavicle fracture is more appropriate to the clinic,which has a certain clinical guiding significance for the selection of treatment methods and prognosis of middle clavicle fracture. Plastic splint is effective in the treatment of middle clavicle fracture without obvious displacement and overlapping displacement,and the incidence of complications is low. It can be popularized in clinic. |
| KEY WORDS Clavicle Fractures Small splint fixation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 朱兴涛,孙轶韬,孙一夫,林顺,姜宏,刘锦涛.锁骨中段骨折分型及可塑性夹板治疗的临床观察[J].中国骨伤,2022,35(3):258~264 |
| 英文格式: | ZHU Xing-tao,SUN Yi-tao,SUN Yi-fu,LIN Shun,JIANG Hong,LIU Jin-tao.Clinical observation on plastic splint treatment of middle clavicle fracture based on a new classification[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(3):258~264 |
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