双钢板内固定治疗锁骨远端粉碎性骨折临床疗效

CLINICAL RESULTS OF DUAL PLATES FIXATION FOR DISTAL COMMINUTED CLAVICLE FRACTURES

目的 探讨双钢板内固定术治疗锁骨远端粉碎性骨折的方法及疗效。方法 回顾分析2011年1月-2012年9月采用切开复位锁骨远端双钢板内固定术治疗的16例锁骨远端粉碎性骨折患者资料。其中男9例,女7例;年龄36～71岁,平均53.6岁。致伤原因：交通事故伤8例,运动伤5例,高处坠落伤3例;均为闭合骨折。其中CraigⅡ类Ⅱ型骨折10例,CraigⅡ类Ⅴ型骨折5例,CraigⅡ类Ⅱ型合并Ⅲ类骨折1例。受伤至手术时间为12～72 h,平均48 h。术后定期X线片明确骨折愈合情况,末次随访时采用美国肩肘外科医师学会（ASES）评分标准评价术后肩关节功能。结果 16例均获随访,随访时间13～17个月,平均13.6个月。X线片示术后骨折均得到解剖复位和骨性愈合,愈合时间为4～6个月,平均5.6个月。随访期间无钢板周围骨折、钢板断裂、畸形愈合、骨不连及创伤性关节炎等并发症发生。末次随访时ASES评分为86～93分,平均91分。结论 采用双钢板内固定术治疗锁骨远端粉碎性骨折,可获得坚强稳定的固定,避免干扰肩锁关节和肩关节活动,是一种安全可靠的治疗方法。

Objective To evaluate the technique and effectiveness of dual plates fixation for distal comminuted clavicle fractures. Methods Between January 2011 and September 2012, 16 patients with distal comminuted clavicle fractures were treated with dual plates fixation. There were 9 males and 7 females with the mean age of 53.6 years （range, 36-71 years）. All the patients had closed fracture, including 10 cases of Craig II/type II, 5 cases of Craig II/type V, and 1 case of Craig II/type II and Craig III, which was caused by traffic accident in 8 cases, by sports in 5 cases, and by falling from height in 3 cases. The average interval from injury to surgery was 48 hours （range, 12-72 hours）. The X-ray films were taken during follow-up. The functional recovery of the shoulder joint was assessed using the American Shoulder and Elbow Surgeons （ASES） rating scale score. Results All the patients were followed up 13-17 months （mean, 13.6 months）. The X-ray films showed bone union and anatomical reduction in all cases, with the mean time of bone healing of 5.6 months （range, 4-6 months）. No complication of implant related fracture, implant failure, malunion, nonunion, or post-traumatic arthritis occurred during follow-up. The mean ASES score was 91 （range, 86-93） at last follow-up. Conclusion Dual plates fixation in the treatment of distal comminuted clavicle fractures can obtain a rigid fixation and avoid the interference of acromioclavicular joint and shoulder joint activities, so this technique is a safe and effective method.