CAJ | 학술논문

目的：探讨锁骨骨折术后内固定失效的原因及预防措施。方法回顾分析该院自2004年1月-2013年12月收治的197例锁骨骨折行骨折内固定术患者，初次手术方法包括：克氏针固定、钢板固定、克氏针张力带固定，对其中出现内固定失效的病例，分析失效原因及采取补救措施。结果所有病例随访6~18个月，其中13例出现内固定失效、骨折不愈合，包括：克氏针固定7例、重建钢板固定5例、克氏针张力带固定1例，13例均采取再次切开复位解剖型钢板内固定，且3例行自体髂骨植骨术，术后6~8个月骨折愈合。结论医源性因素是造成锁骨骨折内固定失效的主要原因。锁骨骨折术后内固定失效与内固定物选择、手术操作及术后功能锻炼方法有密切关系。正确掌握骨折内固定手术操作技巧，合理使用内固定器械，术后科学合理的功能锻炼，是防止锁骨骨折术后内固定失效的关键。
목적：탐토쇄골골절술후내고정실효적원인급예방조시。방법회고분석해원자2004년1월-2013년12월수치적197례쇄골골절행골절내고정술환자，초차수술방법포괄：극씨침고정、강판고정、극씨침장력대고정，대기중출현내고정실효적병례，분석실효원인급채취보구조시。결과소유병례수방6~18개월，기중13례출현내고정실효、골절불유합，포괄：극씨침고정7례、중건강판고정5례、극씨침장력대고정1례，13례균채취재차절개복위해부형강판내고정，차3례행자체가골식골술，술후6~8개월골절유합。결론의원성인소시조성쇄골골절내고정실효적주요원인。쇄골골절술후내고정실효여내고정물선택、수술조작급술후공능단련방법유밀절관계。정학장악골절내고정수술조작기교，합리사용내고정기계，술후과학합리적공능단련，시방지쇄골골절술후내고정실효적관건。
Objective To investigate the causes of fixation failure after clavicle fracture surgery and its countermeasure. Methods 197 patients with clavicle fracture who underwent internal fixation in our hospital during January 2014 and December 2013 were retrospectively analyzed. Initial operative approach included kirschner wire fixation, plate fixation, kirschner wire tension band. The causes of fixation failure and its countermeasure were analyzed. Results During the 6-18 months follow-up, there were 13 cases of fixation failure, including 7cases by kirschner wire fixation, 5 cases by plate fixation and 1 case by kirschner wire tension band, all of which underwent secondary open reduction and internal fixation with anatomical plate, and 3 of them underwent addi-tional autogenous bone grafting. All of them were cured within 6-8 months after reoperation. Conclusion Iatrogenic factors includ-ing fixation material, surgical procedure etc are the main causes of failure of internal fixation of clavicle fracture which, in the same time, has close relation with postoperative functional exercise and other factors. Therefore skillful surgical technique, proper selection of fixation material, reasonable functional exercise are the countermeasure.