微孔锁定钢板辅助锚钉与锁骨钩钢板固定锁骨远端不稳定骨折的疗效对比分析

A comparative analysis of the efficacy of microporous locking plate-assisted anchor and clavicular hook plate in the treatment of unstable distal clavicular fractures

目的比较锁骨远端微孔锁定钢板辅助锚钉与锁骨钩钢板固定锁骨远端不稳定骨折的治疗效果。方法对2014年6月至2018年2月我院收治的54例锁骨远端Neer II型骨折患者,分为微孔解剖锁定钢板辅助锚钉固定组A(26例)和锁骨钩钢板固定组B(28例)。术后通过影像学及临床检查随访,采用X线片评估内固定位置、复位维持及骨折端骨质生长情况,观察肩部疼痛、功能及并发症情况。并用ConstantMurley评分对比两组患者术后疗效。结果治疗后随访12~16个月,术前、术后基线资料两组相比,差异无统计学意义(P>0.05),均未出现感染。末次随访两组X线片显示骨折均骨性愈合,内固定物固定可靠,骨折端及肩锁关节未见错位,锁骨钩钢板固定组中4例出现肩峰部分骨吸收现象,2例出现肩峰及锁骨远端部分骨吸收。A组Constant-Murley末次评分(92.3±3.5)分高于B组(91.0±2.5)分,但两组相比差异无统计学意义(P>0.05),其中肩关节疼痛、内旋活动度评分两组相比,差异有统计学意义(P=0.033,0.001)。结论两种固定方式治疗一般锁骨远端不稳定骨折均能可靠固定,行早期功能训练,取得满意疗效。锁骨钩钢板固定部分患者存在肢体极度内旋受限、疼痛,但取出钢板可得到改善。微孔解剖锁定钢板固定辅助锚钉喙锁韧带重建可以避免锁骨钩钢板固定的肩峰下相关并发症,且可保留内固定物避免二次手术。

Objective To discuss effects of microporous locking plate-assisted anchor and clavicular hook plate in the treatment of unstable distal clavicular fractures.Methods Fifty-four patients with Neer II fracture of the distal clavicle were treated by surgery from June 2014 to February 2018.All patients were divided into 2 groups:group A(n=26),treated with microporous anatomical locking plate-assisted anchor;group B(n=28),treated with clavicular hook plate.The position of the internal fixation,reduction and maintenance,bone growth of the fracture end were evaluated by X-ray,meanwhile the pain,functions and complications of the shoulder were observed.ConstantMurley score was used to compare the effects between the two groups.Results There were no significant differences in baseline data between the two groups after 12 to 16 months of follow-up(P>0.05),and no infection occurred.X-ray reexamination of the last follow-up showed that the fracture healed and the internal fixator was reliable.There was no dislocation at the fracture end or acromioclavicular joint.Four cases had acromial bone resorption,and 2 cases had acromioclavicular and distal clavicular bone resorption in group A.Constant-Murley last score in group A(92.3±3.5)was higher than that in group B(91.0±2.5)with no significant differences(P>0.05).There were significant differences in shoulder pain and internal rotation activity(P=0.033,0.001).Conclusions Both reliable fixations achieve satisfactory results with early functional exercise.Some patients with clavicular hook plate fixation suffer from limitation and pain when extreme internal rotation occurs,but the symptoms could be improved when the plate is removed.Microporous anatomical locking plate fixation assisted with anchor coracoclavicular ligament reconstruction can avoid subacromioclavicular complications associated with clavicular hook plate fixation,and retain the internal fixator to avoid secondary surgery.