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| Clinical Value of Thoracoscopic Reduction and Percutaneous Intramedullary Nailing in the Treatment of Middle Clavicle Fracture |
| PENG Dang-bing, CHEN Cheng-lin |
| Ring Pelvic Area,Xi'an Honghui Hospital, Xi'an Shaanxi, 710000 |
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Abstract 【Objective】 To investigate the clinical value of thoracoscopic reduction and percutaneous intramedullary nailing fixation in the treatment of middle clavicular fracture. 【Methods】 A total of 51 patients with middle clavicle fracture were retrospectively analyzed. According to different surgical methods, they were divided into the control group and the observation group. Patients in the control group (n=33) were treated with traditional manual reduction and percutaneous intramedullary nailing fixation, while 18 patients in the observation group were treated with thoracoscopic-assisted reduction and percutaneous intramedullary nailing fixation. The operation time, intraoperative blood loss, VAS score and fracture healing time of the two groups were compared. The clinical efficacy of the two groups was evaluated by constant Murley score 6 months after operation, and the complications of the two groups during the follow-up period were recorded. 【Results】 In the control group, 4 cases were difficult to reduce during the operation, thus they were temporarily changed to open reduction. Patients in both groups were followed up for 6-18 months, with an average follow-up time of (11.67±3.12) months. The operation time of the observation group was longer than that of the control group (P<0.05). There was no significant difference in the amount of blood loss, VAS score on the day after surgery, and fracture healing time between the two groups (all P>0.05). However, 6 months after surgery, the functional activity, pain, shoulder joint mobility and the scores of muscle strength in the two groups of patients were higher than those before operation (all P<0.05), but there was no statistically significant difference in the scores of the two groups of patients (P>0.05). Follow-up results showed that all patients received anatomical reduction and were healed by first intention. In the control group, 1 case (3.45%) had difficulty in removing intramedullary nail and 1 case (3.45%) had fracture nonunion,whose fracture was successfully healed after 9 months postoperatively with a locking plate revision. The rest of the patients in the two groups had no complications such as intramedullary nail breakage or fracture nonunion during the follow-up period, and all achieved bony union. 【Conclusion】 Although thoracoscopic-assisted reduction and intramedullary nailing internal fixation for the treatment of mid clavicle fracture has a long operation time, no fluoroscopy is needed during the operation, so radiation exposure is avoided; and the clinical effect is equivalent to that of traditional manual reduction and percutaneous intramedullary nail internal fixation.
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Received: 26 October 2020
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2021, Vol. 38 
