不侵扰肩锁关节手术治疗锁骨远端骨折的研究

Acromioclavicular joint sparing technique in surgical treatment for distal clavicle fracture

目的在不侵扰肩锁关节的情况下解决锁骨远端骨折及肩锁关节脱位。方法回顾2011年2月至2013年2月共32例NeerⅡ、Ⅲ型锁骨远端骨折。其中钩钢板（A组）18例，解剖钢板＋喙突埋线（B组）14例。随访时间平均26．7月。收集术后第1天、术后3月、术后1年、术后2年，拍肩锁关节正位片，肩关节疼痛VAS，CS（Constant—murley Shoulder score）、肩关节活动SST（Simple should test）和WS（Walch ACJ score）还有再手术率。结果术后短时内B组功能明显占优。术后3月至1年，两组病人无论影像学还是体征方面无显著差别。A组再手术率明显高于B组。而术后2年A组肩锁关节间隙明显较B组小，且超过1。的肩锁关节脱位较多。结合VAS评分A组差于B组，有临床差异但无统计学意义。结论不侵扰肩锁关节的手术方法治疗锁骨远端骨折为目前较为完善的方案，但有需要注意的地方。同时因为本实验样本数不足，可能还有其他方面情况未能完善揭露，需要进一步研究。

Ohjeetive To find a better way in the surgical treatment of distal clavicle fracture while sparing acromioclavicular joint. Methods February, 2011 to February, 2013, 32 cases of Neer type and distal clavicle fracture were retrospectively reviewed. The were divided into a hook plate group（group A, n=lS） and an anatomy distal clavicle locking plate＋ coranoid screw wire（group B, n=14）. The mean follow- up time was 26.7 months. The A-P view of shoulder X-ray, VAS, CS, SST, and WS scores and reoperation ratio were collected one day, 3 months, 1 year, and 2 years after the operation. Results In short term, group B functioned better. In mid-term（3 months to lyear）, there were no statistical differences between these 2 groups. In long term, group A got a much higher reoperation ratio and narrower ACJ space and more cases ended in grade 2 ACJ dislocation or worse. The VAS was better in group B than in group A, but with no statistical difference. Conclusions ACJ sparing surgical technique for distal clavicle fracture is promising while defeating any other process in current. Several problems should be paid attention to, and more studies should he run.