锁骨远端解剖型锁定钢板微创内固定治疗锁骨中外1/3骨折

Minimally invasive internal fixation for mid lateral 1/3 clavicle fracture with distal clavicular anatomic locking plate

目的:探讨锁骨远端解剖型锁定钢板闭合复位、微创内固定治疗锁骨中外1/3骨折的临床疗效。方法:自2016年2月至2017年3月,采用锁骨远端解剖锁定钢板闭合复位、微创内固定治疗锁骨中外1/3骨折患者32例,其中男24例,女8例;年龄22～68(42.3±12.7)岁;根据Robinson分型:2A2型6例,2B1型18例,2B2型8例。术前均无血管、神经损伤。受伤至手术时间0～6(3.1±1.4) d。对比手术前后双侧锁骨长度以评价骨折复位情况,并于术后6个月采用Constant评分评价患肩功能恢复情况。结果:30例患者获得随访,时间11～18(13.3±2.2)个月。术后无血管、神经损伤、内固定失效、骨折端延迟愈合、不愈合等并发症出现。创面均Ⅰ期愈合,骨折愈合时间8～12(10.2±1.1)周。锁骨短缩长度由术前的(11.2±3.6)%减少至术后2 d的(0.4±0.3)%。10例患者于术后8个月行内固定拆除,术后无再骨折发生。Constant评分由术前的23.53±5.21提高至术后6个月的94.30±5.60,其中优26例,良4例。患者对术后瘢痕美观程度及患肩功能均表示非常满意。结论:采用锁骨远端解剖型锁定钢板闭合复位、微创内固定治疗锁骨中外1/3骨折,可取得良好的手术疗效,具有创伤小、术后恢复快,瘢痕小、不影响美观等优势。

Objective:To investigate clinical effects of minimally-invasive internal fixation for mid-lateral 1/3 clavicle fracture with distal clavicular anatomic locking plate.Methods:From February 2016 to March 2017,32 patients with mid-lateral 1/3 clavicle fractures treated by minimally-invasive internal fixation with distal clavicular anatomic locking plate,including 24 males and 8 females with an average of(42.3±12.7)years old(ranged from 22 to 68 years old).According to Robinson classification,6 patients were type 2A2,18 patients were type 2B1 and 8 patients were type 2B2.No vessel and nerve injury occurred before operation.The time from injury to operation ranged from 0 to 6 days with an average of(3.1±1.4)days.Length of bilateral clavicule were compared before and after operation to evaluate fracture reduction.Constant score at 6 months after operation was applied to assess recovery of shoulder function.Results:Thirty patients were followed up from 11 to 18 months with an average of(13.3±2.2)months.No vessel and nerve injury,implant failure,nonunion or delayed union occurred after operation,and facture wound healed at stageⅠ,the time ranged from 8 to 12 weeks with an average of(10.2±1.1)weeks.Shortened length of clavicle decreased from(11.2±3.6)%before operation to(0.4±0.3)%after operation at 2 days.Ten patients removed internal fixation at 8 months after operation without re-fracture occurred after remove plate.Constant score increased from 23.53±5.21 before operation to 94.30±5.60 after operation at 6 months,and 26 patients got excellent results,and 4 good.Patients were satisfied aesthetic degree of scar and shoulder joint function.Conclusion:Minimally-invasive internal fixation for mid-lateral 1/3 clavicle fracture with distal clavicular anatomic locking plate,which has advantages of less trauma,rapid recover,less scar,could receive good clinical effects and not effect beauty.