解剖锁定钢板治疗急性不稳定性锁骨远端骨折的临床疗效

Outcomes following the treatment of acute unstable distal clavicular fractures using anatomic locking plate

目的探讨解剖锁定钢板治疗急性不稳定性锁骨远端骨折的临床疗效。方法本研究回顾性分析自2012年10月至2015年10月,本院收治的急性不稳定性锁骨远端骨折患者的临床资料。本组共32例,其中男24例,女8例,平均年龄45.7(21~66)岁。平均随访时间18.8(14~36)个月。平均受伤到手术时间3.2(1~15)天。平均手术时间97.8(60~135)min,术中出血量42.2(20~100)ml。选用国产钢板治疗18例,Peri-loc钢板14例。平均骨愈合时间14.5(8~20)周。采用配对Student-t检验比较喙锁距离和末次随访时肩关节功能评分(Constant、UCLA评分)差异。结果锁骨远端骨折块距肩锁关节的最近骨折线平均为22.4(15~32)mm,伤后平均3.2(1~15)天接受解剖锁定钢板固定,其中6例附加骨折块间固定,2例喙锁韧带强化,2例异体骨植骨,骨愈合时间平均为14.5(8~20)周,未观察到主要并发症。术前和末次随访时患侧的喙锁距离增加率(coracoclavicular ratio,CCR)差异有统计学意义(P=0.008),末次随访时患侧和健侧CCR差异无统计学意义(P=0.175);末次随访患侧肩关节Constant评分为91(86~95)分,UCLA评分为30(26~32)分,与健侧相比差异无统计学意义(P=0.13)。结论锁骨远端解剖锁定钢板具有生物力学优势,对>20 mm的远端骨折块可提供可靠的稳定结构且同期联合骨折块间固定和(或)喙锁韧带强化,最大程度避免潜在的内植物失效等主要并发症,是治疗急性不稳定性锁骨远端骨折的一种可行的治疗方案。

Objective To evaluate clinical and radiographic outcomes of the treatment using anatomic locking plate（ ALP） for acute unstable distal clavicular fractures, and to introduce technique strategy. Methods In this retrospective study, 32 patients（ 24 males and 8 females） were collected from October 2012 to October 2015 with an average age of 45.7 years（ range： 21-66 years）. The mean follow-up was 18.8 months（ range： 14-36 months）. The average time to injury was 3.2 days（ range： 1-15 days）. The average operation time： 97.8 min（ range： 60-135 min）. Intraoperative bleeding： 42.2 ml（ range： 20-100 ml）. Eighteen patients were treated with domestic plate and 14 cases with Peri-loc plate. The mean bone healing time was 14.5 weeks（ range： 8-20 weeks）. Results of ConstantMurley Shoulder Outcome Score（ Constant score） and University of California, Los Angeles shoulder rating scale（ UCLA） as well as radiographic data coracoclavicular ratio（ CCR） were recorded. Functional scores and CCR were compared between the affected and contralateral side by paired Student-t test. Results The mean fracture line from AC joint was 22.4 mm（ range： 15-32 mm）. After an average of 3.2 days（ range： 1-15 days） following the injury, anatomical locking plate fixation was performed. Six patients were performed with additional interfragmentary fixation, 2 with coracoclacicular loop-and-sling technique using suture 5#, 2 with bone allograft during open reduction and ALP fixation. The mean bone union time was 14.5 weeks（ range： 8-20 weeks）. No major complications were observed. The CCR of the affected side after operation was statistically and significantly decreased compared with pre-operation（ P = 0.008）, while no significant differences were found in the latest follow-up（ P = 0.175）. The mean Constance score of the injured side： 91（ range： 86-95）; UCLA： 30（ range： 26-32）; no statistically significant differences compared with the contralateral side（ P = 0.13, 0.238 respectively）. Conclusions ALPs have some biomechanical advantages and can provide enough stability in the distal fragment（ size 20 mm from AC joint）, which can be augmented with coracoclacicular sutures and/or intrafragmentary fixation or bone graft simultaneously to avoid potential complications of implant failure. It is applicable in the treatment of acute unstable distal clavicular fractures.