杨建水

摘 要：目的 回顾Nice结在辅助钢板治疗锁骨骨干粉碎型骨折中的疗效。方法 回顾性分析2013年6月～2016年8月21例锁骨骨干粉碎型骨折行切开复位Nice结辅助钢板内固定患者。所有患者均应用Nice结经骨膜下环扎复位骨块，锁骨解剖锁定钢板三维塑形，钢板长跨度、螺钉低密度固定，早期锻炼肩关节。观察患者骨折部位外观、骨折愈合时间、关节活动功能及患病期间生活质量。结果 本组经6个月以上随访，根据Neer评分标准：优13例（61.90%），良8例（38.10%）。骨折在术后3～5个月均骨性愈合，无神经血管压迫症状，患者患病期间生活质量高。其中1例发生并发症，发生率为4.76%。结论 采用Nice结辅助钢板治疗锁骨骨干粉碎型骨折可有效促进骨折愈合，维持上肢带的稳定性，无严重术后并发症，无需再次手术，临床效果良好。

关键词：内固定；Nice结；钢板；锁骨骨折

中图分类号：R687.3 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.06.067

文章编号：1006-1959（2018）06-0185-03

The Application of Nice Knot in Clavicle Fracture

YANG Jian-shui

（Tianjin Wuqing District Traditional Chinese Medicine Hospital，Tianjin 300000，China）

Abstract：Objective To review the effect of Nice junction in the treatment of comminuted fracture of clavicle shaft with auxiliary plate.Methods 21 cases of comminuted fracture of clavicular shaft from June 2013 to August 2016 were analyzed retrospectively.All the patients were treated with Nice's subperiosteal ring to reduce the bone mass.Clavicle anatomically locked plate，long span plate， low density screw fixation，early exercise shoulder joint.The appearance of the fracture site， the time of fracture healing，the function of joint activity and the quality of life during the illness were observed.Results The group was followed up for more than 6 months. According to the standard of Neer score，13 cases were excellent（61.90%），and 8 cases（38.10%）were good.The fracture was healed at 3～5 months after the operation，without the symptoms of neurovascular compression，and the patient had a high quality of life during the period of the disease.There were 1 cases of complications，the incidence of which was 4.76%.Conclusion The use of Nice junction assisted plate in the treatment of comminuted fracture of the clavicle shaft can effectively promote fracture healing，maintain the stability of the upper limb belt，no serious postoperative complications，no need for reoperation，and the clinical effect is good.

Key words：Internal fixation；Nice knot；Plate；Clavicle fracture

鎖骨骨折在临床工作中较为常见，且多为高速、高暴力伤所致，粉碎型骨折较常见。大多数锁骨骨干骨折通过保守治疗可以愈合。但对于锁骨骨干粉碎型骨折且明显移位患者易出现不愈合，现在越来越多的学者采取钢板治疗锁骨骨折，明显降低骨折不愈合发生率，但未降低再手术率。Nice结是由法国Nice地区的Pascal Boileau医师发明[1]。它是一个高张力线结，对于骨折部位的切开复位和重建尤为实用。我科自2013年将Nice结应用于临床，对于锁骨骨干粉碎型骨折我科采用切开复位可吸收缝线以Nice结经骨膜下环扎固定骨块、钢板固定，取得了良好的临床效果。……