Cho分型对成人锁骨远端骨折手术的指导意义

The role of Cho classification for operation of distal clavicle fracture in adult

目的探讨Cho分型对成人不稳定型锁骨远端骨折手术方式的指导意义。方法回顾性分析2018年6月至2020年7月本院收治的62例成人不稳定型锁骨远端骨折患者资料,男39例、女23例,平均年龄(54.3±14.8)岁。按照Cho分型指导原则,其中17例采用切开复位锁骨钩钢板内固定(A组),24例应用切开复位锁骨远端解剖锁定加压钢板内固定(B组),21例采用有限切开复位带袢钛板内固定(C组)。观察记录并统计分析三组患者的手术时间、术中出血量、术中C臂机透视次数、术后住院时间、出院时患肩疼痛视觉模拟评分(visual analogue scales,VAS)、术后6个月时患肩美国加州大学洛杉矶分校(University of California,Los Angeles,UCLA)肩关节评分分级。结果62例患者术后获平均23.9个月(9~34个月)随访。三组患者手术时间、术中出血量、术中C臂机透视次数、术后住院时间比较,差异无统计学意义(P>0.05);出院时A组患肩平均VAS为(5.3±1.4)分,均高于B组(3.3±1.3)分和C组(3.5±1.5)分,差异有统计学意义(P<0.05);根据肩关节功能UCLA分级,术后6个月时A组肩关节功能分级(优8例、良4例、差5例),均低于B组(优20例、良3例、差1例)和C组(优18例、良1例、差2例),差异有统计学意义(P<0.05)。结论成人锁骨远端骨折Cho分型有助于合理选择手术内固定方式,达到最优化的临床效果。

Background Distal clavicle fracture occurs lateral to the attachments of the coracoclavicular(CC)ligaments.Its expanded definition is described as a one-third lateral fracture of the clavicle.The Neer classification or modified Neer classification proposed by Rockwood for distal clavicle fractures has been widely used to determine fracture stability.In 1990,Craig introduced a more detailed classification system by expanding the original Neer classification system.There was no controversy over the surgical indication of distal clavicle fractures combined with concomitant CC ligament rupture.Current reports described many surgical procedures to treat these unstable fractures.However,few studies introduced a treatment alternative,to facilitate the choice of optimal fixation methods according to the classification of distal clavicle fractures.Objective To explore the role of Cho classification as an alternative method of unstable distal clavicle fracture in adults.Methods A retrospective study was conducted to analyze the clinical data of 62 patients with unstable distal clavicle fractures admitted to the No 2 People's Hospital of Changshu from June 2018 to July 2020.There were 39 males and 23 females with an average age of(54.3±14.8)years(range from 23 to 86 years).Seventeen patients were treated with clavicular hook plate fixation(groups A),twenty-four patients experienced distal clavicle microporous locking plate fixation(groups B),and twenty-one patients received mini titanium plate fixation(groups C).The three groups were compared and analyzed with operation time,intraoperative blood loss,intraoperative C-arm fluoroscopy,postoperative hospitalization time,visual analogue scale(VAS)of discharge,and UCLA score for functional recovery of the affected shoulder.Results The mean follow-up time was 23.9 months(9-34 months).There were no significant differences among the three groups in the frequency of operation time,intraoperative blood loss,intraoperative C-arm fluoroscopy,and postoperative hospitalization time(P>0.05).Average VAS in groups A was improved to(5.3±1.4)points when discharged,with a significant difference from(3.3±1.3)points for groups B and a considerable difference from(3.5±1.5)points for groups C(P<0.05).According to UCLA degree system of six months after the operation,excellent results were obtained in 20 patients(83.3%)and good in 3 patients(12.5%)in group B,and excellent results were obtained in 18 patients(85.7%)and good in 1 patient(4.8%)in groups C.In contrast,excellent results were obtained in 8 patients(47.1%)and four patients(23.5%)in group A.There were statistical differences between groups A and groups B(P<0.05),as well as group A and group C(P<0.05).Conclusion The Cho classification system of distal clavicle fracture in adults is reliable and helpful for choosing the optimal fixation methods and achieving superior clinical outcomes.