单纯解剖锁定钢板内固定与联合喙锁韧带重建治疗新鲜和陈旧性NeerⅡb型锁骨远端骨折的疗效比较

Comparison of anatomical locking plate fixation with versus without reconstruction of coracoclavicular ligament in treatment of acute and old NeerⅡb distal clavicle fractures

目的比较单纯解剖锁定钢板内固定与联合喙锁韧带重建治疗新鲜和陈旧性NeerⅡb型锁骨远端骨折的疗效。方法回顾性分析2015年1月至2020年11月间中国药科大学第一附属医院骨科收治的80例NeerⅡb型锁骨远端骨折患者资料,男49例,女31例;年龄32~78岁,平均47.8岁。新鲜骨折50例,其中25例行锁骨远端解剖锁定钢板内固定的同时增加带线锚钉重建喙锁韧带(重建组a),余下25例单纯行锁骨远端解剖锁定钢板内固定(未重建组a)。另有30例伤后超过3周且骨折未愈合的陈旧性NeerⅡb型锁骨远端骨折,其中15例行解剖锁定钢板内固定联合喙锁韧带重建(重建组b),余下15例单纯行解剖锁定钢板内固定(未重建组b)。术后1、3、6个月采用Constant-Murley评分标准和疼痛视觉模拟评分(VAS)评定肩关节功能和疼痛情况;同时复查X线片,测量喙锁间隙,并观察骨折愈合情况。结果所有患者随访6~24个月(平均13.8个月)。重建组a及未重建组a新鲜骨折愈合时间分别为(11.7±2.8)、(13.4±1.3)周,末次随访时患侧喙锁间隙增加率分别为12.7%±6.2%、14.2%±8.0%,末次随访时Constant-Murley评分分别为(92.2±4.4)、(90.9±5.7)分,组间差异均无统计学意义(P>0.05)。重建组b及未重建组b陈旧性骨折愈合时间分别为(12.8±1.9)、(19.4±6.7)周,末次随访时患侧喙锁间隙增加率分别为12.3%±6.7%、21.5%±13.1%,末次随访时Constant-Murley评分分别为(93.0±5.9)、(83.5±8.5)分,组间差异均有统计学意义(P<0.05)。结论对于新鲜NeerⅡb型锁骨远端骨折,单纯解剖锁定钢板内固定能获得满意效果,不需要刻意重建喙锁韧带;对于陈旧性NeerⅡb型锁骨远端骨折,增加喙锁韧带重建能更好地维持骨折端及肩锁关节稳定,降低内固定失败的风险,从而获得更好的疗效。

Objective To compare anatomical locking plate fixation with versus without reconstruction of the coracoclavicular ligament in the treatment of acute and old NeerⅡb unstable distal clavicle fractures.Methods From January 2015 to November 2020,80 NeerⅡb distal clavicle fractures were treated at Department of Orthopaedics,The First Hospital Affiliated to China Pharmaceutical University.There were 49 males and 31 females,aged from 32 to 78 years(average,47.8 years).Of the 50 fresh fractures,25 were treated by internal fixation with anatomical locking plate of distal clavicle plus reconstruction of the coracoclavicular ligament with suture anchor(reconstruction group A)while the other 25 by only internal fixation with anatomical locking plate of distal clavicle(non-reconstruction group A).Of the 30 old fractures which had not got united over 3 weeks after injury,15 were treated by internal fixation with anatomical locking plate of distal clavicle plus reconstruction of the coracoclavicular ligament with suture anchor(reconstruction group B)while the other 15 by only internal fixation with anatomical locking plate of distal clavicle(non-reconstruction group B).At 1,3 and 6 months postoperatively,Constant-Murley scale and visual analogue scale(VAS)were used to evaluate shoulder function and pain.X-ray follow-ups were conducted to measure the coracoclavicular distance and observe fracture union and complications at the last follow-up.Results All the 80 patients were followed up for 6 to 24 months(average,13.8 months).For reconstruction group A and non-reconstruction group A,respectively,the union time for fresh fractures was(11.7±2.8)weeks versus(13.4±1.3)weeks,the rate of coracoclavicular distance increase 12.7%±6.2%versus 14.2%±8.0%,the Constant-Murley score 92.2±4.4 versus 90.9±5.7,showing no statistically significant difference between the 2 groups(all P>0.05).For reconstruction group B and non-reconstruction group B,respectively,the union time for old fractures was(12.8±1.9)weeks versus(19.4±6.7)weeks,the rate of coracoclavicular distance increase 12.3%±6.7%versus 21.5%±13.1%,the Constant-Murley score 93.0±5.9 versus 83.5±8.5,showing statistically significant differences between the 2 groups(all P<0.05).Conclusions For fresh NeerⅡb distal clavicle fractures,simple anatomical locking plate fixation can achieve satisfactory curative efficacy without additional reconstruction of the coracoclavicular ligament.However,for old Neer IIb distal clavicle fractures,additional reconstruction of the coracoclavicular ligament can better maintain the stability of the acromioclavicular joint,reduce the risk of internal fixation failure,and achieve better outcomes.