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

Effectiveness of anatomical locking plate internal fixation combined with coracoclavicular ligament reconstruction for Neer type Ⅱb distal clavicle fractures

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NeerⅡb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NeerⅡb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。

Objective To 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. Methods The 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（nonreconstruction 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. Results All 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 sidein non-reconstruction group was significantly higher than that in reconstruction group（t=2.371, P=0.023）. The ConstantMurley 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）.Conclusion Both 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.