CAJ | 학술논문

目的：探讨成人锁骨中段骨折的分型及相应的治疗方法。方法对我院2004~2012年治疗的成人锁骨中段骨折患者随机抽取100例的资料进行回顾性分析，抽取的病例除外：年龄低于14岁，随访低于6个月，其他诊断影响锁骨骨折的治疗。按骨折块的多少及移位程度分为以下四型：Ⅰ型无论骨折块多少，但其分离移位不超过0.5㎝、旋转移位不超过30°、骨折重叠小于2.0㎝；Ⅱ型主要由骨折远近段两部分构成，但骨折远近断段重叠﹥2.0㎝或成角﹥30°；Ⅲ型除由骨折远近段外还包括第三块主要骨折块，即三部分骨折；Ⅳ型除骨折远近段外尚有另外两块主要骨折块即四部分骨折。治疗Ⅰ型采用保守治疗，Ⅱ型采用保守或手术治疗，Ⅲ、Ⅳ型采取手术治疗，其中Ⅱ型用克氏针或钢板固定，Ⅲ型用钢板固定，Ⅳ型用钢板固定并考虑植骨。结果100例患者随访时间为6个月~23个月，平均13.3个月。100例患者101根锁骨，骨折均达解剖或功能复位，骨折延迟愈合1例，余均顺利愈合。肩关节功能采用美国肩肘外科协会评分(rating scale of the American shoulder and elbow surgeons，ASES)[1]，优36例，良55例，差9例，优良率91%。结论依据成人锁骨中段骨折受伤机制、骨折片的多少及移位程度，予以总结后作出分型，有利于对锁骨中段骨折治疗方式的统一和规范化，提高锁骨骨折的治疗满意率。
목적：탐토성인쇄골중단골절적분형급상응적치료방법。방법대아원2004~2012년치료적성인쇄골중단골절환자수궤추취100례적자료진행회고성분석，추취적병례제외：년령저우14세，수방저우6개월，기타진단영향쇄골골절적치료。안골절괴적다소급이위정도분위이하사형：Ⅰ형무론골절괴다소，단기분리이위불초과0.5㎝、선전이위불초과30°、골절중첩소우2.0㎝；Ⅱ형주요유골절원근단량부분구성，단골절원근단단중첩﹥2.0㎝혹성각﹥30°；Ⅲ형제유골절원근단외환포괄제삼괴주요골절괴，즉삼부분골절；Ⅳ형제골절원근단외상유령외량괴주요골절괴즉사부분골절。치료Ⅰ형채용보수치료，Ⅱ형채용보수혹수술치료，Ⅲ、Ⅳ형채취수술치료，기중Ⅱ형용극씨침혹강판고정，Ⅲ형용강판고정，Ⅳ형용강판고정병고필식골。결과100례환자수방시간위6개월~23개월，평균13.3개월。100례환자101근쇄골，골절균체해부혹공능복위，골절연지유합1례，여균순리유합。견관절공능채용미국견주외과협회평분(rating scale of the American shoulder and elbow surgeons，ASES)[1]，우36례，량55례，차9례，우량솔91%。결론의거성인쇄골중단골절수상궤제、골절편적다소급이위정도，여이총결후작출분형，유리우대쇄골중단골절치료방식적통일화규범화，제고쇄골골절적치료만의솔。
Objective To investigate the type and appropriate treatment of adult clavicle fractures. Methods for treating middle of my adult hospital 2004-2012 clavicle fracture patients randomly selected 100 cases were retrospectively analyzed, except for cases of extraction: younger than 14 years old, less than 6 months fol ow-up, other diagnostic impact fractures col arbone treatment. By the number and degree of displacement of the fracture fragments are divided into the fol owing four types:; ⅡtypeⅠtype mainly by how much, whether the fracture fragments, but it does not exceed 0.5 cm separation shift, rotating shift does not exceed 30 °, the overlap is less than 2.0 cm fracture Two-part fractures distance segment structure, but the fracture near and far-of segment overlap>2.0 cm or angulation>30 °;Ⅲtype addition to the distance from the outer fracture segment also includes a third block of the main fracture fragments, that is, three-part fractures; Ⅳ type fracture in addition to the distance In addition there are two major outer segment fragment that four-part fractures. Treatment of type Ⅰ conservative treatment, Ⅱ type with conservative or surgical treatment,Ⅲ,Ⅳtype of surgical treatment, which Ⅱ type or plate fixation with Kirschner, Ⅲ type with plate fixation, Ⅳ plate fixing and taking graft. The Results of 100 patients were fol owed up for 6 months to 23 months, average 13.3 months. 100 patients 101 clavicle fractures reached anatomical or functional reset, delayed fracture healing one case, I have healed. Shoulder function using the American Shoulder and Elbow Surgeons Society score (rating scale of the American shoulder and elbow surgeons, ASES) [1], excellent in 36 cases, good in 55 cases and poor in 9 cases, good rate of 91%. Conclusions based on adult clavicle fracture mechanism of injury, the number and degree of displacement of the fracture piece, be summed up after making typing, it is beneficial for the treatment of mid-clavicular fractures unified and standardized way to improve the treatment of clavicular fractures satisfaction rate.