目的 比较弹性带锁髓内钉与解剖型锁定钢板治疗锁骨中段骨折的疗效.方法 回顾性分析2014年1月至2016年12月手术治疗47例锁骨骨折患者资料.其中23例采用弹性带锁髓内钉固定(髓内钉组),男14例,女9例;年龄19～85岁,平均55.26岁;左侧14例,右侧9例;根据AO/OTA分型,2A型6例,2B型17例.24例采用解剖型锁定钢板固定(钢板组),男18例,女6例;年龄15～71岁,平均51.25岁;左侧16例,右侧8例;根据AO/OTA分型,2A型9例,2B型15例.比较两组患者的手术时间、术中出血量、皮肤切口长度、骨折愈合时间、内固定取出时间、Constant?Murley肩关节评分、臂肩手功能障碍(disabilities of the arm, shoulder, and hand, DASH)评分以及并发症等.结果 47例患者均顺利完成手术.两组患者均获得随访,髓内钉组随访时间14～23周,平均19.35周;钢板组随访时间28～76周,平均53.13周.髓内钉组手术时间(20.78±7.71)min、术中出血量(13.26±9.72)ml、切口长度(1.57±1.24)cm、骨折愈合时间(10.39±2.39)周、内固定取出时间(13.17±2.37)周、Constant?Murley肩关节评分(99.09±1.86)分、DASH评分(1.20±2.47)分;钢板组手术时间(57.79± 11.56)min、术中出血量(69.17±46.24)ml、切口长度(9.67±2.90)cm、骨折愈合时间(14.21±4.05)周、内固定取出时间(47.38±10.46)周、Constant?Murley肩关节评分(98.00±2.17)分、DASH评分(0.89±1.65)分.与钢板组比较,髓内钉组手术时间短(t=12.856,P=0.000)、术中出血量少(t=5.791,P=0.000)、切口长度明显短(t=12.549,P=0.000)、骨折愈合时间短(t=3.566,P=0.002)、内固定取出时间明显早(t=15.603,P=0.000);以上各指标比较差异均有统计学意义.髓内钉组和钢板组Constant?Murley肩关节评分[(99.09±1.86)分和(98.00±2.17)分]、DASH评分[(1.20±2.47)分和(0.89±1.65)分]比较差异无统计学意义.术后3～6周,髓内钉组6例发生尾端皮肤刺激及滑囊炎,经换药及取内固定后症状消失.钢板组延迟愈合2例,经延长观察,分别至24、27周愈合;感染1例,经切开引流及敏感抗生素应用后治愈;皮肤愈合不良1例,经换药治疗后切口愈合;皮肤刺激症状2例,取内固定后症状消失.结论 弹性带锁髓内钉与解剖型锁定钢板均是治疗锁骨中段骨折的有效手术方式,均可取得良好临床效果.髓内钉组具有微创、骨折愈合快、取内固定时间短、体表美观、费用低等优势.但髓内钉组也存在尾端皮肤刺激及临时滑囊炎的发生.“,”Objective To compare the curative effect between Elastic Locking Intramedullary Nail (ELIN) and Anatomic Locking Plate (ALP) for the treatment of fracture in the mid?shaft of clavicle (Classification AO/OTA:2A/2B). Methods Data of 47 cases of 2A/2B clavicular fractures who were treated with operation from January 2014 to December 2016 were retrospectively analyzed. The patients were divided into ELIN group and ALP group according to different fixation methods. There were 23 cases in ELIN group, 14 male and 9 female, aged from 19 to 85 years (average, 55.26 years).14 cases on the left side and 9 cases on the right side. There were 6 cases of type 2A and 17 cases of type 2B. There were 24 cases in the ALP group, 18 male and 6 fe?male, aged from 15 to 71 years (average, 51.25 years). 16 cases on the left side and 8 cases on the right side. There were 9 cases of type 2A and 15 cases of type 2B. The operation time, intraoperative blood loss, length of skin incision, fracture healing time, ex?traction time of internal fixation, Constant?Murley score of shoulder joint, disabilities of the arm, shoulder, and hand (DASH) score, and complication incidence were compared between the two groups. Results All the operations were successfully performed. The mean follow?up for the patients in the ELIN group was 19.35 weeks (range, 14-23 weeks). The mean follow?up for the patients in the ALP group was 53.13 weeks (range, 28-76 weeks). In the ELIN group, the operative time was 20.78 ± 7.71 min, the intraopera? tive blood loss was 13.26±9.72 ml, the length of incision was 1.57±1.24 cm, the fracture healing time was 10.39±2.39 weeks, the extraction time of internal fixation was 13.17±2.37 weeks, the Constant?Murley score of shoulder joint was 99.09±1.86, and the DASH score was 1.20±2.47. In the ALP group, the operative time was 57.79±11.56 min, the intraoperative blood loss was 69.17± 46.24 ml, the length of incision was 9.67±2.90 cm, the fracture healing time was 14.21±4.05 weeks, the extraction time of internal fixation was 47.38±10.46 weeks, the Constant?Murley score of shoulder joint was 98.00±2.17, and the DASH score was 0.89±1.65. The operation time (t=12.856, P=0.000), intraoperative blood loss (t=5.791, P=0.000) in the ELIN group were less than that of ALP group. The length of incision was significantly smaller in ELIN group than that of ALP group (t=12.549, P=0.000). The frac?ture healing time was earlier in ELIN group than that of ALP group (t=3.566, P=0.002). The extraction time of internal fixation was obviously earlier in ELIN group than that of ALP group (t=15.603, P=0.000). Constant?Murley score of shoulder joint and DASH score showed no significant difference. No delayed healing, no infection was found in the ELIN group, however skin irritation and tail bursitis were found in 6 cases, 3-6 weeks after the operation. The dressing was changed, kept clean. Skin irritation and tail bursitis disappeared, after the extraction of the internal fixation. There were 2 cases of delayed healing in the ALP group. After pro?longed observation, the 2 cases healed. The healing time was extended to 24 and 27 weeks, respectively. There was 1 case of infec?tion, 1 case of poor skin healing in the ALP group. The infected patient was treated with debridement and sensitive antibiotics, and the patient with poor skin healing was treated with dressing change. All the patients had wound healing about 4 weeks after sur?gery. 2 cases of skin irritation in the ALP group disappeared, after the extraction of the internal fixation. Conclusion Both ALP and ELIN are effective methods for the treatment of mid?shaft clavicular fracture. ELIN group has the advantages of more minimal?ly invasive, faster union, shorter internal fixation time, better appearance, and lower medical cost. However, the ELIN group also had skin irritation and temporary bursitis.