两种方法治疗锁骨骨折的疗效分析
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摘要
目的总结分析重建钢板与克氏针两种内固定治疗锁骨骨折的临床疗效。
方法回顾性调查我院1997年9月-2006年7月手术治疗且获随访的40例锁骨骨折患者的资料，其中重建钢板固定组28例，克氏针固定组12例，分析比较两者的治疗效果及优缺点。疗效评定按韩平良等锁骨疗效标准。统计学分析，手术时间、术中出血量、骨折愈合时间采用t检验，术后优良率、并发症发生率采用X~2检验，P＜0.05认为有统计学意义。
结果全部病例随访6月～96月，平均48月。重建钢板固定组：手术时间45 min～85 min，平均60min：术中出血量50ml～100ml，平均80ml；骨折愈合时间2月～5.5月，平均3月；其中1例延迟愈合，1例术后2月发生钢板断裂，拆除内固定重新行重建钢板内固定并植骨后骨折愈合。本组优23例，良3例，差2例，优良率92.8％。克氏针固定组：手术时间35min～60min，平均45min；术中出血量35ml～80ml，平均50ml；骨折愈合时间1.5月～4.5月，平均2.5月；其中畸形愈合2例，延迟愈合2例，遗留肩关节疼痛致活动受限1例。本组优5例，良2例，差5例，优良率58.3％。平均手术时间、术中出血量、骨折愈合时间，两组比较无统计学意义(均P＞0.05)；并发症的发生率，克氏针组高于重建钢板组，有显著性差异(P＜0.05)；术后优良率，重建钢板组高于克氏针组，有显著性差异(P＜0.05)。
结论重建钢板在锁骨骨折内固定中的疗效优于克氏针内固定，具有固定坚强，并发症少，可早期进行肩关节功能锻炼，肩关节功能恢复好的优点。
本研究病例数略少，在反应结果的准确性及全面性上存在一定的局限性。
Objective:
To compare and analyze the effect of surgical treatment for clavicle fracture by reconstruction plate and Kirschner's wire.
Patients and Methods:
Retrospective analyzed surgically treated 40 cases clavicle fractures that can be followed up during 1997.9-2006.7 in XiangYa hospital,28 cases in which were treated by reconstruction plate, 12 cases by Kirschner's wires,compared the effect of these two methods. The effect is assessed according to the standard of Han Ping-liang.The mean operating time, mean bleeding volume, mean heal time adopted t-test.The rate of excellent and good, the disesse incidence of postoperative complications by statistical Chi-square test,P<0.05 is to be considered having statistical significance.
Results:
All the cases were followed up for 6 to 96 months, in reconstruction plate group,mean operating time were 60min(45min～85min),mean bleeding volume were about 80ml (50ml～100ml).Mean heal time were 3 months(2months～5.5months).All 28 fractures healed,1 case suffered delayed union. 1 case suffered a plate breakage 2 months after the operation,this was treated by replating using reconstruction plate and supplemental autogenous iliac crest bonegrafting.The recovery was eventually satisfactory.In this group,23 cases were excellent,3 cases were good,2 cases were acceptable.The rate of excellent and good was 92.8%.InKirschner's wires group,the mean operating time were 45min(35min～60min)mean bleeding volume were50ml(35ml～80ml),mean heal time were 2.5 months(1.5months～4.5months),all the fractures got primary union except 2 cases mal-union for the Kirschner's wire loosened, 2 cases suffered delayed union, 1 case had residual shoulder pain restricting the range of motion.5 cases were excellent,2 cases were good,5cases were bad.The rate of excellent and good was 58.3%.After statistical t-test (P>0.05), there was no differences were found by operating time, bleeding volume and union time,but significant difference in rate of excellent and good. The disesse incidence of postoperative complications is lower in reconstruction plate than In Kirschner's wires group by X -test(P<0.05).
Conclusion:
According to the results,we conclused that reconstruction plate displayed advantages of rigid fixation, and occurs less complication than the Kirschner's wire,and possibility of early functional exercise.The function of the shoulder joint is better.
方法回顾性调查我院1997年9月-2006年7月手术治疗且获随访的40例锁骨骨折患者的资料，其中重建钢板固定组28例，克氏针固定组12例，分析比较两者的治疗效果及优缺点。疗效评定按韩平良等锁骨疗效标准。统计学分析，手术时间、术中出血量、骨折愈合时间采用t检验，术后优良率、并发症发生率采用X~2检验，P＜0.05认为有统计学意义。
结果全部病例随访6月～96月，平均48月。重建钢板固定组：手术时间45 min～85 min，平均60min：术中出血量50ml～100ml，平均80ml；骨折愈合时间2月～5.5月，平均3月；其中1例延迟愈合，1例术后2月发生钢板断裂，拆除内固定重新行重建钢板内固定并植骨后骨折愈合。本组优23例，良3例，差2例，优良率92.8％。克氏针固定组：手术时间35min～60min，平均45min；术中出血量35ml～80ml，平均50ml；骨折愈合时间1.5月～4.5月，平均2.5月；其中畸形愈合2例，延迟愈合2例，遗留肩关节疼痛致活动受限1例。本组优5例，良2例，差5例，优良率58.3％。平均手术时间、术中出血量、骨折愈合时间，两组比较无统计学意义(均P＞0.05)；并发症的发生率，克氏针组高于重建钢板组，有显著性差异(P＜0.05)；术后优良率，重建钢板组高于克氏针组，有显著性差异(P＜0.05)。
结论重建钢板在锁骨骨折内固定中的疗效优于克氏针内固定，具有固定坚强，并发症少，可早期进行肩关节功能锻炼，肩关节功能恢复好的优点。
本研究病例数略少，在反应结果的准确性及全面性上存在一定的局限性。
Objective:
To compare and analyze the effect of surgical treatment for clavicle fracture by reconstruction plate and Kirschner's wire.
Patients and Methods:
Retrospective analyzed surgically treated 40 cases clavicle fractures that can be followed up during 1997.9-2006.7 in XiangYa hospital,28 cases in which were treated by reconstruction plate, 12 cases by Kirschner's wires,compared the effect of these two methods. The effect is assessed according to the standard of Han Ping-liang.The mean operating time, mean bleeding volume, mean heal time adopted t-test.The rate of excellent and good, the disesse incidence of postoperative complications by statistical Chi-square test,P<0.05 is to be considered having statistical significance.
Results:
All the cases were followed up for 6 to 96 months, in reconstruction plate group,mean operating time were 60min(45min～85min),mean bleeding volume were about 80ml (50ml～100ml).Mean heal time were 3 months(2months～5.5months).All 28 fractures healed,1 case suffered delayed union. 1 case suffered a plate breakage 2 months after the operation,this was treated by replating using reconstruction plate and supplemental autogenous iliac crest bonegrafting.The recovery was eventually satisfactory.In this group,23 cases were excellent,3 cases were good,2 cases were acceptable.The rate of excellent and good was 92.8%.InKirschner's wires group,the mean operating time were 45min(35min～60min)mean bleeding volume were50ml(35ml～80ml),mean heal time were 2.5 months(1.5months～4.5months),all the fractures got primary union except 2 cases mal-union for the Kirschner's wire loosened, 2 cases suffered delayed union, 1 case had residual shoulder pain restricting the range of motion.5 cases were excellent,2 cases were good,5cases were bad.The rate of excellent and good was 58.3%.After statistical t-test (P>0.05), there was no differences were found by operating time, bleeding volume and union time,but significant difference in rate of excellent and good. The disesse incidence of postoperative complications is lower in reconstruction plate than In Kirschner's wires group by X -test(P<0.05).
Conclusion:
According to the results,we conclused that reconstruction plate displayed advantages of rigid fixation, and occurs less complication than the Kirschner's wire,and possibility of early functional exercise.The function of the shoulder joint is better.
引文
1. Robinson CMFractures of the clavicle in the adult. Epidemiology and classification. J Bone Jt Surg[Br] 1998; 80-B: 476-84.
2．王亦璁主编．骨与关节损伤．第三版．北京：人民卫生出版社2003．496～505
3. Allman FL Jr. Fractures and ligamentous injuries of the clavicle and its articulation.J Bone Joint Surg[Am] 1967; 49-A: 774-84.
4．卢世壁主译．坎贝尔骨科手术学．第9版．济南：山东科学技术出版社，2001．2227
5. Stanely D, Norris SH.Recovery following fractures of the clavicle treated conservatively.Inj ury 1988; 19: 162-4.
6. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced mid-third frctures of the clavicle gives poor results. J Bone Jt surg[Br] 1997; 79-B:537-79
7. Lazarides S, Zafiropoulos G. Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elbow Surg. 2006 Mar-Apr; 15(2): 191-4
8．韩平良，张文明，藏洪声等．锁骨移位骨折及脱位治疗方案的探讨．中华骨科杂志．1986，2：91-93．
9．尹律平，吴建国，王达忠等．锁骨钢板治疗锁骨中段粉碎性骨折。中国矫形外科杂志，2005，13(20)：1589～159
10. Shen Wun-Jer, Liu Tsung-Jen, Shen Young-Shung. Plate fixation of fresh displaced midshaft clavicle fractures. Injury, 1999 Sep;30(7): 497-500
11. Poigenfurst J, Rappold G, Fischer W. Plating of fresh clavicle frac-tures: results of 122operations [J]. Injury, 1992, 23(2): 237.
12. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007 Jan;89(1):1-10
13. Kee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, Wild LM, Potter J. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006 Jan;88(1): 35-40
14．张海．锁骨骨折内固定方法及疗效比较，医学文选，2003，22(3) 328-329．
15. ChuangTai-Yuan, HO Weipin, Hsieh Pang-Hsin et al.Closed Reduction and Intemal Fixation for Acute Midshaft Clavicular Fractures Using Cannulated Screws.J Trauma,2006,June,60(6): 1315-1321.
16. Chu Cheng-Mien,Wang Shyu-Jye,Lin Leou-Chyr.Fixation of mid-third clavicular fractures with Knowles pins.Acta Orthop Stand 2002;73 (2): 134-139.
17. Jubel A, Andermahr J,Bergmann H,Prokop A, Rehm KE. Elastic stable intramedullary nailing of midclavicular fractures in athletes.Br J Sports Med 2003; 37: 480-484.
18．陈镇秋，胡锐明．3种内固定治疗锁骨骨折疗效分析．实用中西医结合临床．2004， 4(5)： 31-32．
19．陈敖忠．锁骨骨折几种内固定疗效比较[J]．骨与关节损伤杂志，2001，9(16)：376-377．
20．连学全，黄世民，庄耀明等．克氏针固定锁骨的生物力学实验和临床疗效．中华骨科杂志．1994：14(13)：163-165．
21．黄纯聪，刘勇军，贾立，袁世全，张德全，张华义．113例锁骨粉碎性骨折手术治疗体会．现代医药卫生，2005，21(24)：3389-3390．
22．付清海，许河东，杨培淮克氏针逸入大血管一例[J]．骨与关节损伤杂志，2001， 9(16)：376-377。
23．谢庆德，锁骨骨折克氏针内固定刺入肺内一例报告[J]．骨与关节损伤杂志，2001， 16(1)：21
24 Hegemann S, Kleining R, Schindler HG, Holthusen H. Kirschner wire migration in the contralateral lung after osteosynthesis of a clavicular fracture. Unfallchirurg. 2005 Nov; 108(11): 991-3.
25. Priban V, Toufar P. A spinal cord injury caused by a migrating Kirschner wire following osteosynthesis of the clavicle: a case review.Rozhl Chir. 2005 Jul; 84(7): 373-5.
26．张云，金永键，杨茂修等．锁骨骨折克氏针内固定术后并发症分析．中国修复与重建杂志，2004，18(1)
27 Denard PJ, Koval KJ, Cantu RV, Weinstein JN. Management ofmidshaft clavicle fractures in adults. 1: Am J Orthop. 2005 Nov; 34(11): 527-36
28 Collinge C, Devinney S, Herscovici D, DiPasquale T, Sanders R. Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle.J Orthop Trauma. 2006 Nov-Dec;20(10): 680-6.
29 Verborgt O, Pittoors K, Van Glabbeek F, Declercq G, Nuyts R, Somville J. Plate fixation of middle-third fractures of the clavicle in the semi-professional athlete. Acta Orthop Belg. 2005 Feb;71(1):17-21.
30 谢道远，朱江，万彬．锁骨骨折三种内固定方法的临床疗效分析．岭南急诊医学杂志 2004，9(2)：140-141
31 B6stman Ole, Manninen et al. Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma, 1997,43 (5)778-781.
32 王晶，王国普，潘锐．AO重建钢板治疗锁骨粉碎性骨折48例．广州医学院学报 2002，30(1)55-56．
33 Iannotti MR, Crosby LA, Stafford P, etal. Effects of plate location and selection on the stability of midshaft clavicle osteotomies:a biomechanical study.Jshoulder Elbow Surg,2002,11 (5):457-462.
1．王亦璁主编．骨与关节损伤．第三版．北京：人民卫生出版社2003．496～505．
2．蔡伟斌，施国强，苏华甄等．162例锁骨骨折不同固定方法疗效比较．海军医学杂志， 2005，11(6)：49～50．
3．齐进如，何志民，阎辉，刘朋，任世祥．“8”字绷带固定治疗锁骨骨折164例体会．现代中西医结合杂志．2001，10(21)：2051～2052．
4．李家彦，王永荣，贾敏等．抱腹式石膏环形固定治锁骨骨折30例．中华创伤骨科杂志，1999，1(4)：74．
5．卢世壁主译．坎贝尔骨科手术学．第9版．济南：山东科学技术出版社，2001．2227．
6. Stanely D, Norris SH. Recovery following fractures of the clavicle treated conservatively. Injury 1988; 19:162-4.
7．傅强，陈渭良不稳定型锁骨骨折外展式胶布牵引治疗法的临床应用与力学原理探讨广州中医药大学学报，2000，17(3)：247-249．
8. Hill JM, McGuire MH, Crosby LA.Closed treatment of displaced mid-third frctures of the clavicle gives poor results.J Bone Jt surg[Br] 1997;79-B:537-79.
9．章先炎，杨茂清，孙继泽等．锁骨复位后的三维力学分析[J]．医用生物力学杂志， 1994，1：26-29．
10. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the Risk of Nonunion Following Nonoperative Treatment of a Clavicular Fracture. J Bone Jt Surg. Am.2004. 86:1359-1365.
11．荣国威，王承武．骨折M．北京：人民卫生出版社，2004：586．
12．张海．锁骨骨折内固定方法及疗效比较，医学文选，2003，22(3) 328-329．
13．郑万平，成明传，官建，沈自力，肖敏．156例锁骨骨折的几种治疗方法疗效分析．重庆医学，2005，34(9)：1397-1387．
14．连学全，黄世民，庄耀明等．克氏针固定锁骨的生物力学实验和临床疗效．中华骨科杂志．1994；14(13)：163-165．
15．黄纯聪，刘勇军，贾立，袁世全，张德全，张华义．113例锁骨粉碎性骨折手术 治疗体会。现代医药卫生，2005，21(24)：3389-3390．
16．刘长征，汤瑞新，马立泰．骨圆针治疗锁骨骨折(附134例报告)．实用骨科杂志，2004，9(2)：105-106．
17．李培豪．锁骨骨折克氏针内固定并发症18例分析．广西医学，2001，23(1)：167-168
18．黄明光，张普国，曾秋涛，黄必．斯氏针内固定术治疗锁骨中段骨折的疗效和并发症分析．广东医学．2000，21(9) 766-767．
19．付清海，许河东，杨培淮．克氏针逸入大血管一例[J]．骨与关节损伤杂志，2001， 9(16)：376-377。
20．谢庆．锁骨骨折克氏针内固定刺入肺内一例报告[J]．骨与关节损伤杂志，2001， 16(1)： 21．
21．许功效，徐如彬．带螺纹克氏针治疗锁骨骨折．中国厂矿医学．2002，15(1)： 29-30。
22．贾俊．螺纹针内固定治疗锁骨骨折．中国厂矿医学．2002，15(1)：29
23．田红杰，何红让，李红超等．三棱针髓内固定治疗成人锁骨骨折．中国骨伤，2004， 17(10)：611
24. Ngarmukos Chaithavat, Parkpian Vinai, Patradul Adisom. Fixation of fractures of the midshaft of the clavicle with Kirsehner wires:results in 108 patients.J Bone Joint S urg[Br] 1998; 80-B: 106-8.
25．张国庆，张金光，韩文泉．交叉克氏针张力带钢丝内固定治疗锁骨外端NeerⅡ型骨折．中华创伤杂志，1999，15：97．
26. Proubasta IR, Itarte JP, Lamas CG, et al. Midshaft clavicular non-unions treated with the Herbertcannulated bone screw. J Orthop Surg (Hong Kong). 2004 Jun;12(1): 71-5.
27. Jubel A, Andemahr J, Bergmann H, et al. Minimal invasive biological osteosynthesis oftheclavicle with a titanium nail. Kongressbd Dtsch Ges Chir Kongr. 2002; 119: 485-90
28. Jubel A, Andermahr J, Schifferqet al. Technique of intarmedullary osteosynthesis of theclavicle with elastic titanium nails. Unfallchimrg. 2002 Jun; 105(6): 511-6.
29. Proubasta IR, Itarte JP, Caceres EP, et al, Ginebra MP. Biomechanical evaluation of fixation ofclavicular fractures. J South Orthop Assoc. 2002 Fall; 11 (3): 148-52.
30．贾万贵，杜鉴雄，李义芳．6种不同内固定治疗锁骨骨折的体会．实用骨科杂志，2005，11(5)：465．
31．于进祥，杜东鹏，朱泖岷等．喙突移位手术治疗肩锁关节全脱位临床效果分析．中华骨科杂志．1997；17：659-660
32. Hamroongroj T, Vanadurongwan V Biomechanical aspects of plating osteosynthesis oftransverse clavicular fracture with and without inferior cortical defect. Clin Biomech(Bristol, Avon). 1996 Jul; 11(5): 290-294.
33. Iannotti MR, Crosby LA, Stafford P, etal. Effects of plate location and selection on the stability of midshaft clavicle osteotomies:a biomechanical study. Jshoulder Elbow Surg, 2002, 11(5): 457-462
34．覃松，王建一，胡丙艮等．锁骨中段骨折切开复位钢板内固定34例临床分析。临床骨科杂志．2001，Mar，4(1)：65．
35．刘杰，姜炳春，英强等．钢板内固定治疗锁骨骨折65例体会．中国局解手术学杂志．2001，10(2)：187-188．
36．江庭彪，袁华军，刘敬旺．三种内固定方法治疗粉碎性锁骨骨折疗效分析．医学文选，2004，23(5)：597．
37．王开化．重建钢板治疗锁骨中外1／3骨折的疗效观．贵阳医学院学报．2003，28(5) 445-446．
38．孙新宏，秦玉东，史向军．三种内固定方式治疗锁骨骨折临床疗效分析．中国修复重建外科杂志，2004，18(1)：77．
39. Sim E, Schwaiz N, Hocher K et al. Repair of complete acromioclavicular separations using acromion clavicular hook plate. Clin Orthop Relat Res. 1995;314:134-142.
40．邓建龙，刘好源．AO锁骨钩钢板的临床应用．临床骨科杂志，2003，6(3)：264-265．
41. Karlsson J. Acromioclavicular dislocation treated by coracoacromial ligment ransfer. Arch Orthop Trauma Surg,1986,106:811.
42. Flinkklia T, Ristiniemi J, Hyvonen P, et al. Surgical treatment of unstable fractures of the distal clavicle: A comparative study of Kirschner wire and clavicular hook plate fixation. Acta Orthop Scand,2002,73: 50-53.
43. Flinkklia T,Ristiniemi J,Hyvonen P, et al. Hook-plate fixation of unstable lateral clavicle fractures. Acta Orthopaedica 2006; 77(4): 644-649.
44. Meda. Prasad V.k, Machani.B, Sinopidis C et al. Clavicular hook plate for lateral end fractures-A prospective study. Injury,2006,37,277-283.
45．林毅忠，李松军，许鸿灏，何伟东．锁骨钩钢板和重建钢板内固定治疗锁骨远端骨折的疗效分析．实用医学杂志，2004，20(7)：765-757．
46. Fumiki Mizue, Yasumasa Shirai, Hiromoto Ito. Surgical treatment of comminuted fractures of the distal clavicle using wolter clavicular plates.J Nippon Med Sch 2000; 67; 32-34.
47．关春辉．Wolter钢板与张力带固定治疗锁骨远端骨折脱位疗效观察．中国误诊学杂志，2005，August5(9)1644-1645．
48．戴克戎，倪诚，吴小涛等．形状记忆锯齿臂环抱内固定器的实验研究与临床应用．中华外科杂志，1994，32(10)：629．
49．郭永继，范爱香．锁骨骨折不同内固定方法疗效分析．中华创伤骨科杂志，2005， 7(8)：790-791．
50．章兆怀，邵伯林，陈小强．锁骨外固定器治疗锁骨骨折齐齐哈尔医学院学报 2001；22(6)：614-615
51．张勇．外固定架在锁骨骨折中的应用．中医正骨，1999；11(7)：40
52．姜文学，尤佳，宋宝臣等．锁骨空心加压螺纹钉的研制与临床应用．[J]中国矫形外科杂志．2001，8(7)：723
53. ChuangTai-Yuan, HO Weipin, Hsieh Pang-Hsin et al. Closed Reduction and Internal Fixation for Acute Midshaft Clavicular Fractures Using Cannulated Screws.J Trauma, 2006, June,60(6): 1315-1321.
54. ZheJinC, KimHyun-Kon, Min Byoung-Hyun. Surgical Treatment for Distal Clavicle Fracture Associated With Coracoclavicular Ligment Rupture Using a Cannulated Screw Fixation Technique. J Trauma, 2006, June, 60(6),1358-1361.
55. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Jt Surg[Br] 1998; 80-B: 476-84.
2．王亦璁主编．骨与关节损伤．第三版．北京：人民卫生出版社2003．496～505
3. Allman FL Jr. Fractures and ligamentous injuries of the clavicle and its articulation.J Bone Joint Surg[Am] 1967; 49-A: 774-84.
4．卢世壁主译．坎贝尔骨科手术学．第9版．济南：山东科学技术出版社，2001．2227
5. Stanely D, Norris SH.Recovery following fractures of the clavicle treated conservatively.Inj ury 1988; 19: 162-4.
6. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced mid-third frctures of the clavicle gives poor results. J Bone Jt surg[Br] 1997; 79-B:537-79
7. Lazarides S, Zafiropoulos G. Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elbow Surg. 2006 Mar-Apr; 15(2): 191-4
8．韩平良，张文明，藏洪声等．锁骨移位骨折及脱位治疗方案的探讨．中华骨科杂志．1986，2：91-93．
9．尹律平，吴建国，王达忠等．锁骨钢板治疗锁骨中段粉碎性骨折。中国矫形外科杂志，2005，13(20)：1589～159
10. Shen Wun-Jer, Liu Tsung-Jen, Shen Young-Shung. Plate fixation of fresh displaced midshaft clavicle fractures. Injury, 1999 Sep;30(7): 497-500
11. Poigenfurst J, Rappold G, Fischer W. Plating of fresh clavicle frac-tures: results of 122operations [J]. Injury, 1992, 23(2): 237.
12. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007 Jan;89(1):1-10
13. Kee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, Wild LM, Potter J. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006 Jan;88(1): 35-40
14．张海．锁骨骨折内固定方法及疗效比较，医学文选，2003，22(3) 328-329．
15. ChuangTai-Yuan, HO Weipin, Hsieh Pang-Hsin et al.Closed Reduction and Intemal Fixation for Acute Midshaft Clavicular Fractures Using Cannulated Screws.J Trauma,2006,June,60(6): 1315-1321.
16. Chu Cheng-Mien,Wang Shyu-Jye,Lin Leou-Chyr.Fixation of mid-third clavicular fractures with Knowles pins.Acta Orthop Stand 2002;73 (2): 134-139.
17. Jubel A, Andermahr J,Bergmann H,Prokop A, Rehm KE. Elastic stable intramedullary nailing of midclavicular fractures in athletes.Br J Sports Med 2003; 37: 480-484.
18．陈镇秋，胡锐明．3种内固定治疗锁骨骨折疗效分析．实用中西医结合临床．2004， 4(5)： 31-32．
19．陈敖忠．锁骨骨折几种内固定疗效比较[J]．骨与关节损伤杂志，2001，9(16)：376-377．
20．连学全，黄世民，庄耀明等．克氏针固定锁骨的生物力学实验和临床疗效．中华骨科杂志．1994：14(13)：163-165．
21．黄纯聪，刘勇军，贾立，袁世全，张德全，张华义．113例锁骨粉碎性骨折手术治疗体会．现代医药卫生，2005，21(24)：3389-3390．
22．付清海，许河东，杨培淮克氏针逸入大血管一例[J]．骨与关节损伤杂志，2001， 9(16)：376-377。
23．谢庆德，锁骨骨折克氏针内固定刺入肺内一例报告[J]．骨与关节损伤杂志，2001， 16(1)：21
24 Hegemann S, Kleining R, Schindler HG, Holthusen H. Kirschner wire migration in the contralateral lung after osteosynthesis of a clavicular fracture. Unfallchirurg. 2005 Nov; 108(11): 991-3.
25. Priban V, Toufar P. A spinal cord injury caused by a migrating Kirschner wire following osteosynthesis of the clavicle: a case review.Rozhl Chir. 2005 Jul; 84(7): 373-5.
26．张云，金永键，杨茂修等．锁骨骨折克氏针内固定术后并发症分析．中国修复与重建杂志，2004，18(1)
27 Denard PJ, Koval KJ, Cantu RV, Weinstein JN. Management ofmidshaft clavicle fractures in adults. 1: Am J Orthop. 2005 Nov; 34(11): 527-36
28 Collinge C, Devinney S, Herscovici D, DiPasquale T, Sanders R. Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle.J Orthop Trauma. 2006 Nov-Dec;20(10): 680-6.
29 Verborgt O, Pittoors K, Van Glabbeek F, Declercq G, Nuyts R, Somville J. Plate fixation of middle-third fractures of the clavicle in the semi-professional athlete. Acta Orthop Belg. 2005 Feb;71(1):17-21.
30 谢道远，朱江，万彬．锁骨骨折三种内固定方法的临床疗效分析．岭南急诊医学杂志 2004，9(2)：140-141
31 B6stman Ole, Manninen et al. Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma, 1997,43 (5)778-781.
32 王晶，王国普，潘锐．AO重建钢板治疗锁骨粉碎性骨折48例．广州医学院学报 2002，30(1)55-56．
33 Iannotti MR, Crosby LA, Stafford P, etal. Effects of plate location and selection on the stability of midshaft clavicle osteotomies:a biomechanical study.Jshoulder Elbow Surg,2002,11 (5):457-462.
1．王亦璁主编．骨与关节损伤．第三版．北京：人民卫生出版社2003．496～505．
2．蔡伟斌，施国强，苏华甄等．162例锁骨骨折不同固定方法疗效比较．海军医学杂志， 2005，11(6)：49～50．
3．齐进如，何志民，阎辉，刘朋，任世祥．“8”字绷带固定治疗锁骨骨折164例体会．现代中西医结合杂志．2001，10(21)：2051～2052．
4．李家彦，王永荣，贾敏等．抱腹式石膏环形固定治锁骨骨折30例．中华创伤骨科杂志，1999，1(4)：74．
5．卢世壁主译．坎贝尔骨科手术学．第9版．济南：山东科学技术出版社，2001．2227．
6. Stanely D, Norris SH. Recovery following fractures of the clavicle treated conservatively. Injury 1988; 19:162-4.
7．傅强，陈渭良不稳定型锁骨骨折外展式胶布牵引治疗法的临床应用与力学原理探讨广州中医药大学学报，2000，17(3)：247-249．
8. Hill JM, McGuire MH, Crosby LA.Closed treatment of displaced mid-third frctures of the clavicle gives poor results.J Bone Jt surg[Br] 1997;79-B:537-79.
9．章先炎，杨茂清，孙继泽等．锁骨复位后的三维力学分析[J]．医用生物力学杂志， 1994，1：26-29．
10. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the Risk of Nonunion Following Nonoperative Treatment of a Clavicular Fracture. J Bone Jt Surg. Am.2004. 86:1359-1365.
11．荣国威，王承武．骨折M．北京：人民卫生出版社，2004：586．
12．张海．锁骨骨折内固定方法及疗效比较，医学文选，2003，22(3) 328-329．
13．郑万平，成明传，官建，沈自力，肖敏．156例锁骨骨折的几种治疗方法疗效分析．重庆医学，2005，34(9)：1397-1387．
14．连学全，黄世民，庄耀明等．克氏针固定锁骨的生物力学实验和临床疗效．中华骨科杂志．1994；14(13)：163-165．
15．黄纯聪，刘勇军，贾立，袁世全，张德全，张华义．113例锁骨粉碎性骨折手术 治疗体会。现代医药卫生，2005，21(24)：3389-3390．
16．刘长征，汤瑞新，马立泰．骨圆针治疗锁骨骨折(附134例报告)．实用骨科杂志，2004，9(2)：105-106．
17．李培豪．锁骨骨折克氏针内固定并发症18例分析．广西医学，2001，23(1)：167-168
18．黄明光，张普国，曾秋涛，黄必．斯氏针内固定术治疗锁骨中段骨折的疗效和并发症分析．广东医学．2000，21(9) 766-767．
19．付清海，许河东，杨培淮．克氏针逸入大血管一例[J]．骨与关节损伤杂志，2001， 9(16)：376-377。
20．谢庆．锁骨骨折克氏针内固定刺入肺内一例报告[J]．骨与关节损伤杂志，2001， 16(1)： 21．
21．许功效，徐如彬．带螺纹克氏针治疗锁骨骨折．中国厂矿医学．2002，15(1)： 29-30。
22．贾俊．螺纹针内固定治疗锁骨骨折．中国厂矿医学．2002，15(1)：29
23．田红杰，何红让，李红超等．三棱针髓内固定治疗成人锁骨骨折．中国骨伤，2004， 17(10)：611
24. Ngarmukos Chaithavat, Parkpian Vinai, Patradul Adisom. Fixation of fractures of the midshaft of the clavicle with Kirsehner wires:results in 108 patients.J Bone Joint S urg[Br] 1998; 80-B: 106-8.
25．张国庆，张金光，韩文泉．交叉克氏针张力带钢丝内固定治疗锁骨外端NeerⅡ型骨折．中华创伤杂志，1999，15：97．
26. Proubasta IR, Itarte JP, Lamas CG, et al. Midshaft clavicular non-unions treated with the Herbertcannulated bone screw. J Orthop Surg (Hong Kong). 2004 Jun;12(1): 71-5.
27. Jubel A, Andemahr J, Bergmann H, et al. Minimal invasive biological osteosynthesis oftheclavicle with a titanium nail. Kongressbd Dtsch Ges Chir Kongr. 2002; 119: 485-90
28. Jubel A, Andermahr J, Schifferqet al. Technique of intarmedullary osteosynthesis of theclavicle with elastic titanium nails. Unfallchimrg. 2002 Jun; 105(6): 511-6.
29. Proubasta IR, Itarte JP, Caceres EP, et al, Ginebra MP. Biomechanical evaluation of fixation ofclavicular fractures. J South Orthop Assoc. 2002 Fall; 11 (3): 148-52.
30．贾万贵，杜鉴雄，李义芳．6种不同内固定治疗锁骨骨折的体会．实用骨科杂志，2005，11(5)：465．
31．于进祥，杜东鹏，朱泖岷等．喙突移位手术治疗肩锁关节全脱位临床效果分析．中华骨科杂志．1997；17：659-660
32. Hamroongroj T, Vanadurongwan V Biomechanical aspects of plating osteosynthesis oftransverse clavicular fracture with and without inferior cortical defect. Clin Biomech(Bristol, Avon). 1996 Jul; 11(5): 290-294.
33. Iannotti MR, Crosby LA, Stafford P, etal. Effects of plate location and selection on the stability of midshaft clavicle osteotomies:a biomechanical study. Jshoulder Elbow Surg, 2002, 11(5): 457-462
34．覃松，王建一，胡丙艮等．锁骨中段骨折切开复位钢板内固定34例临床分析。临床骨科杂志．2001，Mar，4(1)：65．
35．刘杰，姜炳春，英强等．钢板内固定治疗锁骨骨折65例体会．中国局解手术学杂志．2001，10(2)：187-188．
36．江庭彪，袁华军，刘敬旺．三种内固定方法治疗粉碎性锁骨骨折疗效分析．医学文选，2004，23(5)：597．
37．王开化．重建钢板治疗锁骨中外1／3骨折的疗效观．贵阳医学院学报．2003，28(5) 445-446．
38．孙新宏，秦玉东，史向军．三种内固定方式治疗锁骨骨折临床疗效分析．中国修复重建外科杂志，2004，18(1)：77．
39. Sim E, Schwaiz N, Hocher K et al. Repair of complete acromioclavicular separations using acromion clavicular hook plate. Clin Orthop Relat Res. 1995;314:134-142.
40．邓建龙，刘好源．AO锁骨钩钢板的临床应用．临床骨科杂志，2003，6(3)：264-265．
41. Karlsson J. Acromioclavicular dislocation treated by coracoacromial ligment ransfer. Arch Orthop Trauma Surg,1986,106:811.
42. Flinkklia T, Ristiniemi J, Hyvonen P, et al. Surgical treatment of unstable fractures of the distal clavicle: A comparative study of Kirschner wire and clavicular hook plate fixation. Acta Orthop Scand,2002,73: 50-53.
43. Flinkklia T,Ristiniemi J,Hyvonen P, et al. Hook-plate fixation of unstable lateral clavicle fractures. Acta Orthopaedica 2006; 77(4): 644-649.
44. Meda. Prasad V.k, Machani.B, Sinopidis C et al. Clavicular hook plate for lateral end fractures-A prospective study. Injury,2006,37,277-283.
45．林毅忠，李松军，许鸿灏，何伟东．锁骨钩钢板和重建钢板内固定治疗锁骨远端骨折的疗效分析．实用医学杂志，2004，20(7)：765-757．
46. Fumiki Mizue, Yasumasa Shirai, Hiromoto Ito. Surgical treatment of comminuted fractures of the distal clavicle using wolter clavicular plates.J Nippon Med Sch 2000; 67; 32-34.
47．关春辉．Wolter钢板与张力带固定治疗锁骨远端骨折脱位疗效观察．中国误诊学杂志，2005，August5(9)1644-1645．
48．戴克戎，倪诚，吴小涛等．形状记忆锯齿臂环抱内固定器的实验研究与临床应用．中华外科杂志，1994，32(10)：629．
49．郭永继，范爱香．锁骨骨折不同内固定方法疗效分析．中华创伤骨科杂志，2005， 7(8)：790-791．
50．章兆怀，邵伯林，陈小强．锁骨外固定器治疗锁骨骨折齐齐哈尔医学院学报 2001；22(6)：614-615
51．张勇．外固定架在锁骨骨折中的应用．中医正骨，1999；11(7)：40
52．姜文学，尤佳，宋宝臣等．锁骨空心加压螺纹钉的研制与临床应用．[J]中国矫形外科杂志．2001，8(7)：723
53. ChuangTai-Yuan, HO Weipin, Hsieh Pang-Hsin et al. Closed Reduction and Internal Fixation for Acute Midshaft Clavicular Fractures Using Cannulated Screws.J Trauma, 2006, June,60(6): 1315-1321.
54. ZheJinC, KimHyun-Kon, Min Byoung-Hyun. Surgical Treatment for Distal Clavicle Fracture Associated With Coracoclavicular Ligment Rupture Using a Cannulated Screw Fixation Technique. J Trauma, 2006, June, 60(6),1358-1361.
55. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Jt Surg[Br] 1998; 80-B: 476-84.
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