锁定与非锁定重建钢板治疗锁骨干移位骨折的疗效比较

Treatment of displaced clavicular shaft fracture： a comparison between locking and nonlocking reconstruction plating

目的 回顾性比较直型锁定重建钢板与普通重建钢板治疗锁骨干移位骨折的临床疗效.方法 2006年3月至2010年1月共有97例单侧闭合性锁骨干移位骨折（Edinburgh 2B型）患者接受切开复位钢板内固定手术,其中37例（男22例,女15例;平均年龄41.2岁）采用直型锁定重建钢板固定（锁定钢板组）,60例（男37例,女23例;平均年龄38.5岁）采用直型普通重建钢板固定（普通钢板组）.比较两组患者在内置物失效和肩关节Constant-Murley评分方面的差异.结果 所有患者均获随访,锁定钢板组术后获平均10.7个月（6～12个月）随访,普通钢板组术后获平均9.8个月（6～12个月）随访.锁定钢板组33例患者骨折获愈合,平均愈合时间为4.6个月（3～6个月）.普通钢板组58例患者骨折获愈合,平均愈合时间为4.1个月（3～6个月）.锁定钢板组有4例（10.8%）发生钢板断裂、骨延迟愈合,而普通钢板组仅有1例（1.7%）发生钢板断裂、骨延迟愈合,差异有统计学意义（χ^2=3.914,P=0.048）.Constant-Murley肩关节功能评分：锁定钢板组平均为（87.3±6.5）分（82～95分）,普通钢板组平均为（90.4±3.0）分（83～97分）,两组患者术前与术后肩关节Constant-Murley评分差值比较差异无统计学意义（t=-0.730,P=0.467）.结论 不推荐使用直型锁定重建钢板固定锁骨干移位骨折,尤其是对于简单骨折.

Objective To retrospectively compare the therapeutic effects of straight locking and nonlocking reconstruction plating for displaced clavicular shaft fractures. Methods Between March 2006 and January 2010, 97 patients with single-sided, isolated, displaced clavicular shaft fractures （Edinburgh 2B）were treated with open reduction and plate fixation. Thirty-seven cases （22 males and 15 females with a mean age of 41.2 years） received straight locking reconstruction plating and 60 cases （37 males and 23 females with a mean age of 38.5 years） had nonlocking reconstruction plating. We compared the hardware failure rates and the Constant-Murley scores for the suffered shoulders between the 2 groups. Results The mean follow-up period was 10. 7 months （range, 6 to 12 months） in the locking group, and 9. 8 months （range, 6 to 12 months） in the nonlocking group. In the locking plate group, 33 fractures healed uneventfully with an average healing time of 4. 6 months （range, 3 to 6 months）. In the nonlocking plate group, 58 fractures healed with an average healing time of 4. 1 months （range, 3 to 6 months） . A significantly higher plate breakage rate （10. 8% ） was observed in the locking plate group than in the nonlocking group （1.7%） （χ^2 = 3. 914, P =0. 048）. The Constant-Murley score was 87.3 ±6. 5 （range, 82 to 95） in the locking plate group and 90.4 ±3.0 （range, 83 to 97） in the nonlocking plate group, without any significant difference between the 2 groups （ t = - 0. 730, P = 0. 467 ）. Conclusion It may not be appropriate to treat a displaced clavicular shaft fracture, particularly a simple one, with a straight locking reconstruction plate.