钢板联合镜下喙锁韧带重建治疗锁骨外侧端骨折

Anatomic locking plate combined with arthroscopic coracoclavicular ligament reconstruction using endobutton for treatment of Neer type IIB fracture of the lateral clavicle

[目的]探讨锁骨外侧端骨折治疗方法。[方法]使用解剖锁定钢板联合镜下喙锁间固定治疗Neer IIB型锁骨外侧端骨折,采用侧卧位,患侧上臂外展前屈位牵引,制作关节镜后侧入路及前上入路,盂肱关节内打开肩袖间隙,显露喙突根部下表面,然后锁骨上表面皮肤横行切开,显露锁骨外侧骨折端,清理骨折端,复位并临时固定,预放置钢板并记录,插入导向器,打入导针,拉入袢钢板,使袢钢板卡于喙突下,袢从锁骨骨道上方拉出,穿入预选钢板,解除骨折端临时固定,旋转钢板调整骨折复位,旋入螺丝钉固定。[结果]8例患者术后平均随访10个月,骨折均愈合,平均愈合时间4.5个月(2.5~6个月)。术前喙锁间平均距离21.5 mm,术后平均10.9 mm,与健侧对比无明显增加,肩锁关节间隙无增宽及骨性关节炎表现。患肩活动度与健侧对比没有明显差异。[结论]本固定技术具有微创、固定牢固、康复快、美观、满意度高等优点,同时可处理盂肱关节内合并伤,无需取出内固定,临床效果满意,并发症率低。

[Objective] To explore an effective surgical treatment for Neer type IIB fracture of the lateral clavicle. [Methods] In the surgical procedure, the lateral position was applied for the patient and the posterior and anterior arthroscopic approaches were made. The interval of rotator cuff was then open in glenohumeral joint cavity to explore the inferior surface of coracoid process. Subsequently, a transverse incision over lateral clavicle surface was sectioned to reveal, reduce and maintain fracture reduction with a temporary fixation. A proper anatomic locking plate was selected and a suitable hole was marked corresponding to conoid ligament attachment for coracoclavicular reconstruction. Afterward, a bone tunnel was created through the clavicle at the mark and an endobutton with the suitable length of loop was inserted through the tunnel. The selected plate was then fixed in position through the loop above the clavicle to fit the button firmly seating under the coracoid process. Final- ly, after releasing the temporary fixation, the plate was fixed with screws. [Results] Eight patients receiving this surgical treatment were followed up for an average of 10 months. The fractures healed solidly in all of the patients after average of 4.5 months. The eoracoclavicular space of the injured sides decreased from 21.5 mm before surgery to 10.9 mm at the last follow up, showing no significant difference compared to the healthy side. No widening of acromioelavicular space or degenerative change of the joint presented in any patients. There was no significant difference in any ranges of motion of the shoulder comparing both sides. [Conclusion] This technique has advantages of minimal invasion, stable fixation, cosmetic improvement and low complication rate. Therefore, it is an effective treatment for Neer type lib distal clavicle fracture.