摘要
[目的]比较钩钢板与解剖锁定板联合喙锁缝线固定治疗锁骨远端骨折的临床疗效。[方法]回顾性分析本院2012年～2016年收治的39例锁骨远端骨折患者的临床资料,其中采用钩钢板固定(钩板组) 18例、解剖锁定板联合喙锁缝线固定(复合组) 21例。比较两组手术时间、术中出血量、骨愈合时间及术后患肩功能Constant-Murley评分、喙锁间距(coracoclavicle distance, CCD)及内固定相关并发症等。[结果]所有患者均顺利手术,无血管、神经损伤等严重并发症。两组手术时间、术中出血量的差异均无统计学意义(P>0.05)。所有患者随访13～40个月,平均(24.55±6.56)个月,均在3个月内获得骨性愈合,两组骨愈合时间的差异无统计学意义(P>0.05)。至末次随访,除肌力评分外,复合组患肩Constant功能评价,术后肩痛、日常功能、关节活动度评分以及总分均优于钩板组,差异有统计学意义(P<0.05)。钩板组术后及末次随访CCD均明显小于复合组,差异具有统计学意义(P<0.05)。此外,钩板组有5例内固定相关并发症:1例锁骨近端应力性骨折、1例螺钉松动伴肩峰下骨溶解、3例肩锁关节炎,而复合组无1例晚期并发症。[结论]解剖锁定板联合喙锁缝线固定治疗锁骨远端骨折的临床疗效优于钩钢板,且并发症少。
[Objective] To compare the clinical outcomes of hook plate versus anatomic locking plate combined with coracoclavicular suture fixation for unstable distal clavicular fractures. [Methods] Between 2012 and 2016, 39 patients with Neer type IB unstable clavicular fractures were enrolled in this retrospective study. Of them, 18 patients had fractures fixed with clavicular hook plate, while the remaining 21 patients received internal fixation by anatomical locking plate combined with coracoclavicular suture fixation. The operation time, intraoperative blood loss, complications, fracture healing time and Constant-Murley score, as well as coracoclavicular distance(CCD) measured radiographically were compared between the two groups. [Results]All the patients had operation performed smoothly without serious complications, such as neurovascular injuries. No significant differences were proved between the two groups regarding to operation time and intraoperative blood loss(P>0.05). The patients were followed up from 13 to 40 months with an average of(24.55±6.56) months. All of them got fracture healing within 3 months after operation, without a significant difference in fracture healing time between the two groups(P>0.05). At the latest followup, the combined group was significantly superior to the hook plate group in the shoulder pain, daily function, range of motion sub scores and the total score of Constant-Murley score(P<0.05), although no significant difference in muscle strength sub score between them(P>0.05). In term of radiographic assessment, the CCD in the hook plate group was significantly less than the combined group immediately postoperatively and at the latest follow up(P<0.05). However, 5 cases of late complicationswere found in the hook plate group, including 1 of proximal stress fracture, 1 of screw loosening accompanied with subacromial osteolysis, and 3 cases of degenerative acromioclavicular arthritis, whereas no late complication happened in any patient of the combined group. [Conclusion] The ana-tomical locking plate combined with coracoclavicular suture fixation is superior to the hook plate for unstable distal clavicle fractures in clinical outcomes, with fewer complications.
作者
曾金才
朱立帆
钱学峰
言湛军
ZENG Jin-cai;ZHU Li-fan;QIAN Xue-feng;YAN Zhan-jun(Deptartment of Orthopaedics,The Affiliated Wujiang Hospital,Nantong University,Wujiang 215200,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第24期2225-2229,共5页
Orthopedic Journal of China
关键词
锁骨远端骨折
锁定钢板
喙锁重建
联合固定
distal clavicle fractures
locking plate
coracoclavicular reconstruction
combined fixation
