解剖型锁定钢板与钩钢板治疗不稳定锁骨远端骨折的疗效分析

The Efficacy of Anatomic Locking Plate and Hook Plate in the Treatment of Unstable Distal Clavicle Fractures

目的评估钩钢板和解剖型锁定钢板治疗NeerⅡ型锁骨远端骨折的临床疗效。方法回顾性分析2013年5月至2016年1月在我院接受手术治疗的NeerⅡ型锁骨远端骨折患者共40例,分为两组。钩钢板组共27例,男16例,女11例;年龄19~74岁,平均(43.37±16.18)岁。锁定钢板组共13例,男11例,女2例;年龄23~74岁,平均(43.46±16.65)岁。比较两组患者在骨愈合情况、并发症发生率、术后肩关节功能方面的不同。肩关节功能评价使用constant评分和UCLA评分。结果两组患者均达到骨愈合并获得满意的临床和影像学结果。钩钢板组:constant评分(87.8±4.9)分,UCLA评分(30.7±2.8)分;锁定钢板组:constant评分(90.2±2.7)分,UCLA评分(31.8±2.2)分。两者在评价肩关节临床结果的constant和UCLA评分比较,差异无统计学意义,但锁定钢板组并发症发生率低于钩钢板组。结论在不稳定锁骨远端骨折的治疗中,解剖型锁定钢板和钩钢板都可以获得满意的临床结果,但解剖型锁定钢板并发症发生率低,即使未修复喙锁韧带肩关节功能恢复也并未受影响。因此,治疗不稳定锁骨远端骨折可以优先考虑使用解剖型锁定钢板。

Objective To evaluate the clinical and radiologic outcomes of unstable distal clavicle fractures treated with anatomic plate and hook plate.Methods Between 2013.5 and 2016.1,40 patients with unstable distal clavicle frac- tures underwent open reduction and internal fixation at our institution with either a clavicular hook plate （27 patients） or a distal clavicular locking plate （13 patients） or a clavicular hook plate （27 patients） were evaluated.The main out- come comparisons included rate of union, rate of complication and the shoulder joint functional which evaluated using Constant and California-Los Angeles （UCLA） scores.Results Bone union was achieved in all patients.Satisfactory clin- ical and radiologic outcomes were obtained.Between the patients who used hook plate [Constant score （87.8 ± 4.9）; UCLA score （30.7±2.8）land the patients who used locking plate[Constant score （90.2±2.7）;UCLA score （31.8±2. 2） ] and the patients who used hook plate[ Constant score （87.8± 4.9） ] UCLA score （ 30.7 ± 2.8） ], there was no statisti- cally significant difference in clinical outcomes of Constant score and UCLA score. However, the results indicated that the locking plate group had a lower rate of complications.Conclusion Both distal clavicular locking plate and clavicular hook plate achieved good results in the treatment of unstable distal clavicle fractures;however,internal fixation with a distal clavicular locking plate had a lower rate of complications,patients without additional coraclavicular ligament aug- mentation also achieved satisfactory shoulder functional outcomes.Therefore, anatomic locking plate can be considered the first of the treatment options for unstable distal clavicle fracture.