锁骨骨折内固定失效的原因分析及对策

目的：探讨锁骨骨折切开复位内固定术后内固定失效的原因,并寻找补救方案。方法：选择我院2007年5月~2010年5月收治的184例锁骨骨折患者,其中男性123例,女性61例,年龄24~76岁,对手术切开复位内固定失败病例的内固定方法进行对比,分析内固定失效的原因,并选取记忆合金环抱器或天鹅型记忆接骨器作为再次手术的内固定器械,分析其临床疗效。结果：本组所有病例均获得6~24个月随访,所有患者首次手术均行钢板内固定治疗,其中应用重建钢板治疗48例,解剖钢板治疗86例,锁骨钩钢板治疗50例,3例术后发生钢板或螺钉断裂患者选用记忆合金环抱器重新手术内固定治疗,2例痊愈,1例记忆合金环抱器再次发生断裂,改用天鹅型记忆接骨器治疗获得痊愈。3例骨不连患者均选择天鹅型记忆接骨器配合植骨内固定治疗,术后恢复良好。结论：锁骨骨折切开复位内固定术后内固定失败的原因主要与所使用内固定技术不合理及患者早期不正确的功能锻炼有关。记忆合金环抱器和天鹅型记忆接骨器均可作为钢板内固定失败术后的补救方案,但天鹅型记忆接骨器较记忆合金环抱器可提供更好的纵向加压作用,治疗钢板断裂及骨不连患者更为可靠。

Analysis and Solutions of the Clavicle Fracture Fixation Failure

Objective： To investigate the reasons of internal fixation failure after the open reduction surgery of clavicular fracture,and to seek several effective countermeasures. Methods： 184 patients（123 males and 61 females, aged 24-76 years） with clavicle fracture who were undergoing the surgery in our hospital from May 2007 to May 2010 were selected. Then the reasons of failing in the fracture fixation were analyzed and the feasible countermeasures were proposed. Results： All patients in this study underwent a 6-24 months＇ follow-up. Plate fixation method was adopted in all initial surgeries, among which there were 48 cases of reconstruction plate therapy, 86of anatomical plate therapy and 50 of clavicular hook plate therapy. After the initial surgeries, 3 patients who underwent postoperative steel plate or screw fracture were re-operated with Shape memory alloy embracing fixator. Of these 3 re-operated cases, 2 were fully recovered; while 1 experienced rupture of Shape memory alloy embracing fixator, and recovered after the application of swan-like memory-compressive connector. Of the 3 bone nonunion patients, swan-like memory-compressive connector therapy combined with internal fixation on bone grafting resulted in encouraging postoperative recovery. Conclusion： Failed clavicle fracture surgery mainly resulted from incorrect internal fixation methodology and improper physical exercise habits of the patients. Shape memory alloy embracing fixator and swan-like memory-compressive connector are proved to be effective remedial plans of failed plate fixation surgeries, however, swan-like memory-compressive connector provides better longitudinal pressure than Shape memory alloy embracing fixator, thus a more reliable treatment for plate fracture and bone nonunion patients.