带袢钢板重建喙锁韧带与锁骨钩钢板治疗锁骨远端骨折的病例对照研究

Comparison of two methods for the treatment of distal clavicle fractures:endobutton and ethibond suture reconstituting coracoclavicular ligament vs clavicle hook plate

目的:探讨带袢钢板加爱惜帮缝线双束重建喙锁韧带和锁骨钩钢板治疗NeerⅡ型锁骨远端骨折的疗效差异。方法:2008年11月至2009年12月,采用带袢钢板加爱惜帮缝线双束重建喙锁韧带(A组8例)和锁骨钩钢板(B组10例)治疗18例锁骨远端骨折患者,其中男10例,女8例,年龄28～65岁,平均38岁。所有损伤均为新鲜损伤,X线表现为NeerⅡ型锁骨远端骨折,损伤至手术时间为2～5d,平均2.8d。所有患者受伤前肩关节活动均正常。术后第1、2、3个月对患肩功能用Constant Murley评分系统进行评分。结果:两组患者切口均Ⅰ期愈合,无感染发生,无臂丛神经损伤。X线提示,所有骨折在术后3个月时有连续骨小梁通过,证实骨折愈合。所有患者均获得随访,时间3～8个月,平均5.7个月。术后第1、2、3个月,A组Constant Murley评分分值分别为:(91.4±6.7)、(97.5±2.6)、(98.3±2.0)分;B组分别为:(70.1±5.1)、(89.0±7.6)、(94.2±4.6)分。在术后1、2、3个月,A组的肩关节评分均高于B组,差异具有统计学意义(P<0.05)。结论:带袢钢板加爱惜帮缝线双束重建喙锁韧带治疗NeerⅡ型锁骨远端骨折,由于不影响肩锁关节,患者可以获得更好的肩关节功能,虽然这一固定方式是非坚强固定,但是所有骨折均愈合。这一技术的应用有赖于完整和坚强的喙突,在小喙突和骨质疏松的患者中可能不适用。

Objective：To research the therapeutic effects of two methods to Neer typeⅡ distal clavicle fracture treated with coracoclavicular ligament reconstruction using endobutton and clavicle hook plate. Methods：From November 2008 to December 2009,18 patients with distal clavicle fracture were treated with endobutton and ethibond suture to re-establish the coracoclavicular ligament（8 cases in group A） and clavicle hook plate（10 cases in group B）. There were 10 males and 8 females with an average age of 38 years ranging 28 to 65 year. All of them were fresh injury,X-ray findings as Neer typeⅡclavicular fracture. Damage to the operation time was 2 to 5 days（averaged 2.8 days）. All patients had normal shoulder function before injury. The shoulder function was evaluated by Constant-Murley score system at the end of 1st,2nd,3rd month after operation. Results：All of the incisions were healed without infection,no brachial plexus injury. Fracture healing was confirmed in the 3rd month after surgery by X-ray. All of the patients were followed up for 3 to 8 months（averaged of 5.7 months）. The scores in group A were 91.4±6.7,97.5±2.6,98.3±2.0 at the end of 1st,2nd,3rd month after operation individual. Meanwhile the scores in group B were 70.1±5.1,89.0±7.6,94.2±4.6. The difference between these two groups were significant（P0.05） at the end of 1st,2nd,3rd month after operation. Conclusion：Comparing with clavicle hook plate,the clinic outcome was excellent to treat Neer typeⅡdistal clavicle fracture with coracoclavicular ligament double bundle restitution using endobutton and ethibond suture,because the treatment of ligament restitution keep the acromioclavicular joint perfectly. All of the fractures were healed although ligament restitution is not a strong fixation. This technique bases on a strong and intact coracoid,and is not fit for the patient with thin coracoid process,or of osteoporosis.