Neer Ⅱ型锁骨远端不稳定骨折的内固定治疗

Internal fixation of the unstable Neer type Ⅱ distal clavicle fractures

目的探讨采用克氏针张力带内固定和肩锁钩钢板内固定治疗NeerⅡ型锁骨远端不稳定骨折的疗效。方法1999年7月-2007年3月治疗48例NeerⅡ型锁骨远端不稳定骨折患者。采用克氏针张力带内固定方法治疗31例患者（克氏针张力带内固定组），肩锁钩钢板内固定方法治疗17例患者（肩锁钩钢板内固定组）。结果随访6—24个月，平均（13±5）个月。两组患者术后伤口无感染发生。克氏针张力带内固定组有4例克氏针向皮下退出，2例发生骨不连，其余29例骨折均顺利愈合。肩锁钩钢板内固定组无内固定松动、断裂等并发症发生，骨折均顺利愈合。采用Herseoviei标准评定肩关节功能，克氏针张力带内固定组优良率80．6％，肩锁钩钢板内固定组优良率94．1％。两组并发症发生率和肩关节功能优良率比较差异均有统计学意义（P〈0．05）。结论对于NeerⅡ型锁骨远端不稳定骨折，肩锁钩钢板较克氏针张力带具有固定更可靠、更有利于肩关节功能康复、并发症发生率低等优点，但价格较昂贵不利于推广应用是其缺点。

Objective To investigate the outcome of Neer type Ⅱ unstable fractures of the distal part of the clavicle treated by internal fixation using tension band or acromioclavicular hook plate. Methods Retrospectively reviewed 48 Neer type Ⅱ unstable fractures of the distal part of the clavicle treated from July 1999 to March 2007. Thirty-one of the patients were treated by tension band internal fixation （tension band internal fixation group） and the other 17 patients were treated by acromioclavicular hook plate internal fixation（acromioclavicular hook plate internal fixation group）. Results Forty-eight patients were followed up for a mean time of （ 13 ± 5）months （6-24 months）. No wound infection was found. In tension band internal fixation group,there were 4 Kirschner wire loosening and 2 fracture nonunion found. In acromioclavicular hook plate internal fixation group, there were no implant loosening and nonunion found. On the basis of the Herscovici rating system, 18 patients had an excellent resuh,7 had a good resuh,4 had a fair result and 2 had a poor result in tension band internal fixation group, good rate was 80.6%. In acromioclavicular hook plate internal fixation group, 12 patients had an excellent result, 4 had a good result and 1 had a fair result, good rate was 94.1%. Conclusions To treat Neer type 11 unstable fractures of the distal part of the clavicle, acromioclavicular hook plate internal fixafion has superior clinical outcome in shoulder function, implant failure, and the rate of complications than tension band internal fixation.