CAJ | 학술논문

背景：儿童锁骨骨折一般均不主张切开复位，因为厚韧的骨膜仍然完整，并由韧带附着。临床上常用双圈固定法和单纯悬吊法外固定，至于采用何种方法可以达到更好的效果，目前尚无可靠的依据。 　　目的：比较单纯悬吊法与双圈固定法治疗儿童锁骨骨折的稳定性。 　　方法：2008年6月至2012年12月采用单纯悬吊法与双圈固定法治疗儿童锁骨骨折，17例采用单纯悬吊法，22例采用双圈固定法，定期行X射线检查，观察骨折愈合情况及肩部功能。 　　结果与结论：单纯悬吊法17例患儿配合良好，骨折愈合良好；3例患儿骨折处断端1周后检查有分离，再次悬吊提高高度后1例恢复骨折处的接触，2例仍有分离，改为双圈固定法固定后，断端接触。双圈固定组22例患者均骨折愈合；5例患儿固定后，有骨折侧上肢神经血管受压的表现，松解后，3例缓解，2例改为单纯悬吊固定后，断端接触；腋下发红6例；早期睡眠困难4例；2例骨折处断端1周后检查有分离，再次调整松紧后，2例恢复骨折处的接触。结果显示2种疗法均不会造成外观畸形，骨折均愈合。单纯悬吊固定，操作简单，疗效可靠，儿童舒适易于接受，可早期功能锻炼，对组织损伤小，不会影响血运；双圈固定法外固定易压迫两侧腋下动脉及神经，出现双上肢肿胀、麻痛、皮肤发红，夜间睡眠不适，患儿舒适度差，不易接受。但是不管采用何种方法，1周后的复查以及远近端对线、骨折断端的接触很重要。
배경：인동쇄골골절일반균불주장절개복위，인위후인적골막잉연완정，병유인대부착。림상상상용쌍권고정법화단순현조법외고정，지우채용하충방법가이체도경호적효과，목전상무가고적의거。 　　목적：비교단순현조법여쌍권고정법치료인동쇄골골절적은정성。 　　방법：2008년6월지2012년12월채용단순현조법여쌍권고정법치료인동쇄골골절，17례채용단순현조법，22례채용쌍권고정법，정기행X사선검사，관찰골절유합정황급견부공능。 　　결과여결론：단순현조법17례환인배합량호，골절유합량호；3례환인골절처단단1주후검사유분리，재차현조제고고도후1례회복골절처적접촉，2례잉유분리，개위쌍권고정법고정후，단단접촉。쌍권고정조22례환자균골절유합；5례환인고정후，유골절측상지신경혈관수압적표현，송해후，3례완해，2례개위단순현조고정후，단단접촉；액하발홍6례；조기수면곤난4례；2례골절처단단1주후검사유분리，재차조정송긴후，2례회복골절처적접촉。결과현시2충요법균불회조성외관기형，골절균유합。단순현조고정，조작간단，료효가고，인동서괄역우접수，가조기공능단련，대조직손상소，불회영향혈운；쌍권고정법외고정역압박량측액하동맥급신경，출현쌍상지종창、마통、피부발홍，야간수면불괄，환인서괄도차，불역접수。단시불관채용하충방법，1주후적복사이급원근단대선、골절단단적접촉흔중요。
BACKGROUND:Open reduction is general y not advocated for the treatment of children clavicle fracture, because the thick and tough periosteum remains intact and attached by the ligament attachment. In clinic, twin-ring external fixation and simple suspension are commonly used, but there is no reliable basis on which method can get better effect. OBJECTIVE:To compare the stability of twin-ring external fixation and simple suspension for the treatment of children clavicle fracture. METHODS:The patients with children clavicle fracture and treated by twin-ring external fixation and simple suspension were selected from June 2008 to December 2012, including 17 patients treated with simple suspension and 22 patients treated with twin-ring external fixation. The X-ray film examination was performed regularly to observe the fracture healing and shoulder function. RESULTS AND CONCLUSION:The 17 patients treated with simple suspension had good healing;three cases had gap between fracture ends at 1 week after treatment, and re-suspension to increase the height and final y two fracture ends contacted in one case;for the other two cases, there was stil gap between fracture ends, and changed for twin-ring external fixation, the fracture ends contacted. Al the 22 patients in the twin-ring external fixation group obtained healing;five cases had performance of upper extremity neurovascular compression on the fracture side after fixation;after releasing, three cases had recovery, and two cases were treated with simple suspension, the fracture ends began to contact;six cases had armpit redness;four cases had early sleep difficulties;two cases had gap between fracture ends at 1 week after treatment, and after re-adjust, the fracture ends contacted in two cases. The results showed both two methods could not cause appearance deformity, and both could get healing. The simple suspension fixation is easy to operate with reliable effect, and it is comfortable which make it easy to accept by the children, it has the advantages of early for functional exercise, less tissue damage, does not affect the blood supply;the twin-ring external fixation is easy to compress the axil ary arteries and nerves on both sides, thus resulting in upper extremity swel ing, numbness and skin redness, and it can cause discomfort night sleeping and poor comfort which is not easy for children to accept. But, no matter what method we take, the review after 1 week, as wel as the line between proximal and distal part and the contact between fracture ends is stil important.