中国修复重建外科杂志

中国修复重建外科杂志

解剖锁定钢板内固定联合喙锁韧带重建治疗 Neer Ⅱb 型锁骨远端骨折的疗效研究

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目的通过与单纯解剖锁定钢板治疗比较,探讨解剖锁定钢板内固定联合喙锁韧带重建治疗 Neer Ⅱb 型锁骨远端骨折的临床疗效。方法回顾分析 2013 年 2 月—2017 年 1 月收治并符合选择标准的 40 例 Neer Ⅱb 型锁骨远端骨折患者临床资料,其中 18 例采用解剖锁定钢板内固定联合 1 枚锚钉重建喙锁韧带治疗(重建组),22 例采用单纯解剖锁定钢板内固定治疗(非重建组)。两组患者性别、年龄、受伤侧别、致伤原因、合并伤、受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组手术时间、医疗费用以及术后患侧喙锁间距、肩关节 Constant-Murley 评分、并发症发生情况。结果两组患者均获随访,随访时间 12~27 个月,平均 16.3 个月。重建组 1 例术后发生切口浅表感染,非重建组 1 例术后 1 个月发生钢板螺钉从远端骨块中拔出伴复位丢失。重建组手术时间及医疗费用均较非重建组明显增加(P<0.05)。末次随访时,骨折均达骨性愈合,重建组患侧喙锁间距增加率明显低于非重建组(t=2.371,P=0.023)。术前及术后 1、3 个月及末次随访时,两组 Constant-Murley 评分比较差异均无统计学意义(P>0.05);但组内术后各时间点评分均高于术前,差异均有统计学意义(P<0.05)。结论对于 NeerⅡb 型锁骨远端骨折,无论是否行喙锁韧带重建,采用解剖锁定钢板内固定后均能获得良好疗效。因此,除远端骨块小于 1 cm 的粉碎性骨折或依从性较差者外,无需常规重建喙锁韧带。

ObjectiveTo investigate the effectiveness of anatomical locking plate internal fixation combined with coracoclavicular ligament reconstruction in treatment of the Neer type Ⅱb distal clavicle fractures by comparing with the simple anatomical locking plate internal fixation.MethodsThe clinical data of 40 patients with Neer type Ⅱb distal clavicle fractures who met the criteria between February 2013 and January 2017 were analyzed. Eighteen cases were treated with anatomical locking plate internal fixation and coracoclavicular ligament reconstruction by using a suture anchor (reconstruction group), and 22 cases were treated only with anatomical locking plate internal fixation (non-reconstruction group). There was no significant difference in gender, age, injured side, causes of injury, associated injuries, time from injury to operation between 2 groups (P>0.05). The operation time, medical expense, postoperative coracoclavicular distance, Constant-Murley scores of injured side, and complications were recorded and compared between 2 groups.ResultsAll patients were followed up 12-27 months (mean, 16.3 months). One patient in reconstruction group had superficial wound infection. One patient in non-reconstruction group had pullout of screws from the distal fragment and reduction loss at 1 month postoperatively. The operation time and medical expense in reconstruction group significantly increased when compared with those in non-reconstruction group (P<0.05). All fractures in 2 groups achieved bony union at last follow-up. The rate of coracoclavicular distance increase of injured side in non-reconstruction group was significantly higher than that in reconstruction group (t=2.371, P=0.023). The Constant-Murley scores at 1 month, 3 months after operation, and last follow-up were significantly improved when compared with preoperative values in 2 groups (P<0.05), but no significant difference was observed between 2 groups (P>0.05).ConclusionBoth anatomical locking plate internal fixation with and without coracoclavicular ligament reconstruction can achieve good effectiveness for the Neer type Ⅱb distal clavicle fractures. Therefore, the coracoclavicular ligament reconstruction is not necessary, except for comminuted fractures with the length of lateral fragment less than 1 cm or the patients with poor compliance.

关键词: 锁骨远端骨折; 解剖锁定钢板; 内固定; 喙锁韧带重建

Key words: Distal clavicle fracture; anatomical locking plate; internal fixation; coracoclavicular ligament reconstruction

引用本文: 汤红伟, 殷勇, 韩擎天, 徐小平, 李云飞. 解剖锁定钢板内固定联合喙锁韧带重建治疗 Neer Ⅱb 型锁骨远端骨折的疗效研究. 中国修复重建外科杂志, 2018, 32(9): 1181-1186. doi: 10.7507/1002-1892.201803127 复制

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1. Sandstrom CK, Gross JA, Kennedy SA. Distal clavicle fracture radiography and treatment: a pictorial essay. Emerg Radiol, 2018, 25(3): 311-319.
2. Ockert B, Wiedemann E, Haasters F. Distal clavicle fractures. Classifications and management. Unfallchirurg, 2015, 118(5): 397-406.
3. Erdle B, Izadpanah K, Jaeger M, et al. Comparative analysis of locking plate versus hook plate osteosynthesis of Neer type ⅡB lateral clavicle fractures. Arch Orthop Trauma Surg, 2017, 137(5): 651-662.
4. Kanchanatawan W, Wongthongsalee P. Management of acute unstable distal clavicle fracture with a modified coracoclavicular stabilization technique using a bidirectional coracoclavicular loop system. Eur J Orthop Surg Traumatol, 2016, 26(2): 139-143.
5. Kwak SH, Lee YH, Kim DW, et al. Treatment of unstable distal clavicle fractures with multiple steinmann Pins-A modification of Neer’s method: A series of 56 consecutive cases. J Orthop Trauma, 2017, 31(9): 472-478.
6. Lee W, Choi CH, Choi YR, et al. Clavicle hook plate fixation for distal-third clavicle fracture (Neer type Ⅱ): comparison of clinical and radiologic outcomes between Neer types ⅡA and ⅡB. J Shoulder Elbow Surg, 2017, 26(7): 1210-1215.
7. Cho CH, Jung JH, Kim BS. Coracoclavicular stabilization using a suture button device for Neer type ⅡB lateral clavicle fractures. J Shoulder Elbow Surg, 2017, 26(5): 804-808.
8. Fleming MA, Dachs R, Maqungo S, et al. Angular stable fixation of displaced distal-third clavicle fractures with superior precontoured locking plates. J Shoulder Elbow Surg, 2015, 24(5): 700-704.
9. Govindasamy R, Kasirajan S, Doke T. Functional results of unstable (Type 2) distal clavicle fractures treated with superior anterior locking plate. Arch Bone Jt Surg, 2017, 5(6): 394-399.
10. Han L, Hu Y, Quan R, et al. Treatment of Neer Ⅱb distal clavicle fractures using anatomical locked plate fixation with coracoclavicular ligament augmentation. J Hand Surg (Am), 2017, 42(12): 1036.e1-1036.e6.
11. 朱立帆, 曾金才, 蒋富贵, 等. 解剖锁定板联合聚酯缝线固定治疗 NeerⅡB 型锁骨远端骨折. 中国修复重建外科杂志, 2017, 31(6): 760-761.
12. Fan J, Zhang Y, Huang Q, et al. Comparison of treatment of acute unstable distal clavicle fractures using anatomical locking plates with versus without additional suture anchor fixation. Med Sci Monit, 2017, 23: 5455-5461.
13. Madsen W, Yaseen Z, LaFrance R, et al. Addition of a suture anchor for coracoclavicular fixation to a superior locking plate improves stability of type ⅡB distal clavicle fractures. Arthroscopy, 2013, 29(6): 998-1004.
14. Vaishya R, Vijay V, Khanna V. Outcome of distal end clavicle fractures treated with locking plates. Chin J Traumatol, 2017, 20(1): 45-48.
15. Brouwer KM, Wright TC, Ring DC. Failure of superior locking clavicle plate by axial pull-out of the lateral screws: a report of four cases. J Shoulder Elbow Surg, 2008, 18(1): e22-e25.
16. Rieser GR, Edwards K, Gould GC, et al. Distal-third clavicle fracture fixation: a biomechanical evaluation of fixation. J Shoulder Elbow Surg, 2013, 22(6): 848-855.
17. Nandra R, Kowalski T, Kalogrianitis S. Innovative use of single-incision internal fixation of distal clavicle fractures augmented with coracoclavicular stabilisation. Eur J Orthop Surg Traumatol, 2017, 27(8): 1057-1062.
18. 林三福, 姚学东, 戴章生, 等. 解剖锁定钢板结合锚钉与锁骨钩钢板治疗 Neer Ⅱb 型锁骨远端骨折的疗效比较. 中华创伤骨科杂志, 2017, 19(1): 41-46.
19. Shin SJ, Ko YW, Lee J, et al. Use of plate fixation without coracoclavicular ligament augmentation for unstable distal clavicle fractures. J Shoulder Elbow Surg, 2016, 25(6): 942-948.
20. Seyhan M, Kocaoglu B, Kiyak G, et al. Anatomic locking plate and coracoclavicular stabilization with suture endo-button technique is superior in the treatment of Neer Type Ⅱ distal clavicle fractures. Eur J Orthop Surg Traumatol, 2015, 25(5): 827-832.
21. Shin SJ, Kim NK. Complications after arthroscopic coracoclavicular reconstruction using a single adjustable-loop-length suspensory fixation device in acute acromioclavicular joint dislocation. Arthroscopy, 2015, 31(5): 816-824.