辅助微型钢板联合LCP治疗粉碎性锁骨中段骨折

Operative Treatment of Comminuted Midshaft Clavicluar Fracture Using Assistant Mini Plate Combined with Locking Compression Plate(LCP)

目的探讨采用前侧辅助微型钢板联合锁定加压钢板(locking compression plates,LCP)固定治疗粉碎性锁骨中段骨折的临床疗效。方法回顾性分析2013年1月至2016年12月采用辅助微型钢板联合LCP治疗并获得随访的13例粉碎性锁骨中段骨折患者,男9例,女4例;年龄20~51岁,平均(32.7±8.8)岁。OTA分型15B2型8例,15B3型5例。所有患者均手术切开复位,锁骨前侧采用2.0mm系统微型钢板辅助复位并固定粉碎骨块,锁骨上方采用LCP固定,术中均达到解剖复位。术后吊带悬吊患肢2周后即开始肩关节功能锻炼,术后1、3、6、12个月,之后每隔6个月复查,摄锁骨正位X线片,采用Constant-Murley肩关节功能评分及疼痛视觉模拟评分评估肢体功能,同时记录骨折愈合时间和术后并发症情况。结果 13例患者随访12~24个月,平均(16.6±5.0)个月。所有患者均骨性愈合,愈合时间2~6个月,平均(3.5±1.3)个月,未出现畸形愈合及骨不愈合。疼痛视觉模拟评分0~3分,平均(1.6±1.2)分。末次随访时Constant-Murley评分85~95分,平均(90.4±3.4)分,其中优9例,良4例,优良率100%。结论采用辅助微型钢板联合LCP治疗粉碎性锁骨中段骨折可以帮助术中解剖复位,增强骨折固定的强度和稳定性,术后随访取得了良好的临床疗效,为处理复杂粉碎性锁骨中段骨折提供了一种可靠的治疗选择。

Objective To investigate the clinical outcomes of LCP fixation assisted with an additional mini plate in the treatment of comminuted midshaft clavicle fractures. Methods Between January 2013 and December 2016,the clinical data of 13 cases of comminuted midshaft clavicle fractures which had been treated with dual plates fixation were retrospectively reviewed.There were 9 male patients and 4 female patients with a mean age of 32.7years.8 cases were 15B2 type and 5 cases were 15B3 type by OTA classification.The major fracture was fixed by LCP on the superior side of clavicle and the comminuted fragments were fixed by mini plate anteriorly.All the 13 cases obtained anatomical reduction.Early exercises started after 2 weeks of sling support.Patients were followed up at the 1st,3rd,6th,12th and then every 6 months postoperatively.Radiographic evaluation was performed utilizing conventional anteroposterior（AP） view.Constant-Murley score and VAS （visual analogue pain score） were used to evaluate the limb function and pain situation.The time of bony union and postoperative complications were recorded. Results 13 patients were followed up for 12~24 months,with an average of 16.6 months.All patients obtained bony union.The union time was 2~6 months,with a mean time of 3.5 months.No malunion or nonunion were observed.At the last follow-up,the mean Constant-Murley score was 90.4 （85~95）（9 excellent,4 good）and the excellent and good rate was 100%.The mean VAS score was 1.6 （1~3）. Conclusion This study demonstrates that LCP fixation assisted with an additional mini plate is a reliable option for comminuted midshaft clavicle fractures,which can help to obtain anatomical reduction,and provide adequate fracture fixation.