锁骨钩钢板治疗锁骨远端不稳定骨折疗效分析

Effect of clavicle hook plate fi xation on unstable distal clavicle fracture

目的 探讨锁骨钩钢板治疗锁骨远端不稳定骨折（Neer Ⅱ型） 中延迟手术是否与术后肩关节功能和并发症相关。方法 回顾我院2009 年1 月- 2012 年2 月采用钩钢板治疗Neer Ⅱ型骨折46 例。按手术时间分为急性手术治疗组（ ＜ 3 周，29 例） 和延迟手术治疗组（ ≥ 3 周，17 例）。末次随访时，根据Constant 肩关节评分评定患侧肩关节的功能，记录术后并发症。结果 46 例均获得随访，随访时间6 ~ 18 个月，平均12.5 个月。X 线片复查示43 例愈合，愈合率为93.5%。急性手术组平均Constant 评分（82 ~ 100 分，平均94 分） 比延迟手术组（68 ~ 85 分，平均73 分） 高（P =0.008）。延迟手术组并发症发生率（35.3%，6/17） 比急性手术组（6.9%，2/29） 高（P =0.045）。结论 外科手术时间在钩钢板治疗Neer Ⅱ型骨折中起着重要作用，延迟手术与较差的术后功能和较高的并发症有关。

Objective To study whether delayed operation is related with shoulder joint function and complications in treatment of unstable distal clavicle fracture （Neer type Ⅱ ） with clavicle hook plate. Methods Forty-six patients with Neer type Ⅱ fracture who underwent clavicle hook plate fixation in our hospital from January 2009 to February 2012 were retrospectively analyzed. The patients were divided into acute operation （ ＜ 3 weeks） group （n=29） and delayed operation （ ≥ 3 weeks） group （n=17） according to their operation time. Shoulder joint function of the patients was assessed according to their constant shoulder joint scores and postoperative complications were recorded. Results The 46 patients were followed up for an average period of 12.5 months （range 6 to 18 months）. X-ray examination showed that the unstable distal clavicle fracture was healed in 43 patients （95.3%）. The average constant score was higher in acute operation group than in delayed operation group （94 vs 73, 82 - 100 vs 68 - 85, P=0.008）. The incidence of complication was higher in delayed operation group than in acute operation group （35.3% vs 6.9%, 6/17 vs 2/29, P=0.045）. Conclusion Surgical operation time plays an important role in treatment of Neer type Ⅱ fracture. Delayed operation is related with the poorer shoulder joint function and higher complication rate of patients with Neer type Ⅱ fracture.