锁定与普通重建钢板治疗移位锁骨中段骨折的疗效比较

Comparison of locking and common reconstruction plate in treatment of displaced midshaft clavicular fractures

目的比较锁定重建钢板与普通重建钢板治疗移位锁骨中段骨折的疗效。方法对自2008年1月一2012年1月采用锁定或普通重建钢板治疗且获得随访的136例锁骨中段移位骨折的资料进行回顾性分析，其中54例采用直形锁定重建钢板固定（锁定钢板组），82例采用普通重建钢板固定（普通钢板组）。比较两组在内固定物失效和肩关节Constant—Murley评分方面的差异。结果锁定钢板组获6～18个月，平均14个月的随访，普通钢板组获8。20个月，平均16个月的随访。影像学显示锁定钢板组骨折愈合时间平均4．5个月（3-6个月），普通钢板组骨折愈合时间平均4．8个月（4—8个月）。锁定钢板组有6例（11．1％）发生锁钉拔出松动、钢板断裂及骨延迟愈合，普通钢板组有2例（2．4％）发生钢板断裂及骨折延迟愈合，差异有统计学意义（χ^2=4．423，P=0．035）。两组术后1年肩关节Constant—Murley评分比较差异无统计学意义（t=0．738。P=O．462）。结论锁骨中段骨折采用普通重建钢板治疗效果满意，不推荐常规应用直形锁定重建钢板固定，尤其是简单骨折。

Objective To compare the clinical results of straight locking and common reconstruction plate in the treatment of displaced midshaft clavicular fratures. Methods From January 2008 to January 2012, 136 patients with displaced midshaft clavicular fractures were treated with locking and common reconstruction. Fifty-four patients received straight locking reconstruction plate and 82 had common reconstruction plate. The hardware failure rates and the Constant-Murley scores for the suffered shoulders were compared between the two gourps. Results The mean follow-up period was 14 months （range form 6 to 18 months） in the locking group, and 16 months （range form 8 to 20 months） in the common reconstruction plate group. The mean radiographic bone union time for locking plate group was 4.5 months （range from 3 to 6 months） and 4.8 months （range from 4 to 8 months） for common reconstruction plate group. A significantly higher plate breakage rate （11.1%） was observed in the locking plate group than in the common reconstruction plate group （2.4%）（X^2=4.423, P =0.035）. There was no significantly difference between the 2 groups in Constant-Murley scores （t =-0.738, P=0.462）. Conclusion Treating patients with displaced midshaft clavicular fractures with common reconstruction plate could receive satisfactory results. It may not be appropriate to treat a displaced midshaft clavicular fracture with a straight locking reconstruction plate, particularly a simple one.