解剖锁定钢板与锁骨钩钢板治疗锁骨远端Neer Ⅱ型骨折的临床疗效

Clinical outcomes of treating Neer Ⅱ distal clavicle fractures with anatomical locking plate and clavicular hook plate

目的 比较解剖锁定钢板和锁骨钩钢板治疗锁骨远端NeerⅡ型骨折的临床疗效.方法 回顾性分析2009年8月至2013年2月对45例锁骨远端NeerⅡ型骨折患者,其中采用解剖锁定钢板（A组）20例,采用锁骨钩钢板（B组）25例.术后随访X线片,观察骨折愈合、内固定物在位情况及肩关节功能评定.结果 45例均获得10～13个月的随访,平均11.4个月.两组骨折均愈合良好,无感染等并发症.B组1例患者术后6个月出现内固定断裂.按照Constant-Murley评分系统评定肩关节功能,术后1、3、6个月及内固定拆除后末次随访时,A组总评分各为88.6±6.2、90.6±4.8、96.6±3.6和98.8± 1.2,均高于B组76.6±4.4、84.4±4.6、87.2±3.8和92.8±4.3,差异有统计学意义（P＜0.01）.结论 两组患者内固定术后均取得了满意的疗效,但解剖锁定钢板操作更简单,固定牢靠,并发症少,术后肩关节功能恢复好,是治疗锁骨远端NeerⅡ型骨折的有效方法之一.

Objective To compare the clinical outcomes of treating Neer type Ⅱ distal clavicle fractures with anatomical locking plate and clavicular hook plate.Methods A retrospective review of 45 cases of Neer Ⅱ distal clavicular fractures treated from August 2009 to February 2013 was conducted.Among them 20 cases were treated with anatomical locking plate （group A）,while 25 cases were treated with clavicular hook plate （group B）.Preoperative conditions of the patients in the two groups were comparable （P ＞ 0.05）.Postoperatively shoulder functions were evaluated using the Constant-Murley score system.Postoperative radiographic findings,fracture healing,hardware position and complications in patients of the two groups were also studied and compared.Results The mean duration of postoperative follow-up was 11.4 months（range,10 to 13 months）.There were no nonunion,infection and other complications.The breakage of internal fixation hardware occurred in 1 patient treated with clavicular hook plate 6 months postoperatively.The Constant-Murley scores at postoperative 1,3,6 months and at last follow-up after hardware removal were the scores of 88.6 ± 6.2,90.6 ± 4.8,96.6 ± 3.6 and 98.8 ± 1.2,respectively,for the anatomical locking plate group,and 76.6 ± 4.4,84.4 ± 4.6,87.2 ± 3.8 and 92.8 ± 4.3,respectively,for the clavicular hook plate group.Shoulder functions in group A at all the follow-up time points were better than these in group B.The differences between these two groups were statistically significant （P ＜ 0.01）.Conclusion Satisfactory results are obtained in both groups.However,anatomical locking plate fixation is easier to operate,leads to more reliable fixation,fewer complications and better shoulder function recovery.It is therefore the treatment of choice for Neer type Ⅱ distal clavicular fractures.