锁扣带袢钛板和锁骨钩钢板治疗Neer Ⅱ型锁骨远端骨折

Comparison of double titanium plate and clavicular hook plate for the treatment of Neer Ⅱdistal clavicular fracture

目的 ：对比锁扣带袢钛板和锁骨钩钢板治疗NeerⅡ型锁骨远端骨折的临床疗效。方法 ：自2013年4月至2015年6月,非随机选择42例NeerⅡ型锁骨远端骨折患者,其中男25例,女17例,均为新鲜闭合性骨折。接受锁扣带袢钛板治疗20例（A组）,男11例,女9例;年龄16~49岁,平均（33.8±10.7）岁;受伤至手术时间2~5 d,平均（3.5±1.8）d。锁骨钩钢板治疗22例（B组）,男14例,女8例;年龄27~53岁,平均（37.7±9.9）岁;受伤至手术时间为2~5 d,平均（3.1±2.0）d。观察并记录患者的手术时间、术中出血量、住院时间及术后并发症情况,比较术前及术后1、3、6个月骨折愈合情况,并采用VAS评分和ASES评分系统评定肩关节功能。结果：两组患者均获随访,时间6~12个月,平均7.2个月。所有患者切口Ⅰ级愈合。A组出血量明显少于B组（P〈0.05）;而两组的手术时间、住院时间比较差异无统计学意义。A组术后无肩痛发生,B组有4例出现肩痛,两组比较差异有统计学意义。两组患者骨折愈合时间3~6个月,平均4.3个月。A组在术后1、3、6个月的VAS评分,ASES评分中除了稳定性与B组比较差异无统计学意义,在疼痛、功能和总分上均明显高于B组。结论：相对于锁骨钩钢板,锁扣带袢钛板具有切口短、创伤小,出血少,操作简单的优点,不仅术后并发症少,而且避免了再次手术取出内固定的痛苦,术中肩锁关节的过度复位亦不影响其优越的疗效,是治疗NeerⅡ型锁骨远端骨折的更佳选择。

Objective：To compare clinical efficacy of double titanium plate and clavicular hook plate for the treatment of Neer Ⅱ distal clavicular fracture. Methods：From April 2013 to June 2015,42 patients with Neer Ⅱ distal clavicle fractures were non randomly selected,including 25 males and 17 females. All patients were fresh closed fractures. Twenty patients were treated with double titanium plate with tight rope（group A）,including 11 males and 9 females aged from 16 to 49 years old with an average age of（33.8±10.7） years;the time from injury to operation ranged from 2 to 5 days with an average of（3.5±1.8） days. Twenty two patients were treated with clavicle hook plate（group B）,including 14 males and 8 females aged from 27 to 53 years old with an average age of（37.7±9.9） years;the time from injury to operation ranged from 2 to 5 days with an average of（3.1±2.0） days. Operative time,blood loss,hospital stays and postoperative complications were observed and compared;fracture healing were compared among preoperative,postoperative at 1,3 and 6 months;VAS and ASES scoring were used to evaluate shoulder function. Results：All patients were followed up from 6 to 12 months with an average of 7.2 months. All incisions were healed at stage Ⅰ. Blood loss in group A were less than that of group B（P0.05）; while there were no significant difference in hospital stays and operative time between two groups. No shoulder pain occurred in group A,4 cases occurred shoulder pain in group B,and had significant difference. Fracture healing time ranged from 3 to 6 months with an average of 4.3months. VAS score and ASES score in group A were higher than that of group B in pain,function and total score. Conclusion：Compared with clavicle hook plate,double titanium plate has advantages of shorter incision wound,less bleeding and simply operation,less complications,and could avoid pain for removing internal fixation. Over reduction of acromioclavicular joint during operation does not affect its superior curative effect. It is better choice for the treatment of Neer Ⅱdistal clavicle fracture.