带胸大肌蒂锁骨膜瓣转移治疗锁骨骨折不愈合

Repair of ununited clavicular fracture with pectoralis major periosteal flap

目的 探讨带胸大肌蒂锁骨膜瓣治疗锁骨骨折不愈合的疗效。方法 自2003年6月至2005年12月，应用带胸大肌蒂锁骨膜瓣转移斯氏针内固定治疗锁骨骨折不愈合12例。以Constant法评定肩关节功能，术前评分平均42．3分（35～51分）。结果 术后10～16周骨折端有大量骨痂生长，骨折线模糊，全部患者获骨性愈合。经4个月～3年（平均1．2年）随访，Constant评分平均达94．3分（92～98分）。全部患者无疼痛症状，有1例患者因术前制动时间长而关节活动度受限（外展2分，屈曲6分，内旋6分，外旋4分），无切口感染。结论 应用带胸大肌蒂锁骨膜瓣治疗锁骨骨折不愈合，效果确切，方法简便，并发症少，术后肩功能恢复满意。

Objective To investigate the clinical effect of the pectoralis major periosteal flap in treatment of nonunion of clavicular fracture. Methods From June 2003 to December 2005, 12 patients with ununited clavicular fractures were treated with pectoralis major periosteal flap and internal fixation with Steinmann＇ s wire. The shoulder joint function was evaluated by the Constant method and the mean score was 42.3 points （35-51 points ） preoperatively. All patients were followed up for average 1.2 years （ranging from 4 months to 3 years）. Results All patients obtained bone union, with well developed callus in the fracture site 10-16 weeks after surgery. Constant points ranged from 92 to 98 points （ mean 94.3 points）. No joint pain or incision infection occurred. One patient had limited range of motion of the shoulder joint owing to long period of preoperative immobilization. Conclusion Pectoralis major periosteal flap is reliable and effective for treatment of nonunion of clavicular fractures, with satisfactory recovery of shoulder joint function.