双钢板内固定治疗锁骨中段粉碎性骨折

Double plates internal fixation in comminuted fracture of middle clavicle

目的探讨双钢板内固定治疗锁骨中段粉碎性骨折的临床效果。方法将44例AO分型B2、C2型的锁骨中段粉碎性骨折患者根据内固定方式不同分为双钢板组(21例,采用双钢板内固定治疗)和单钢板组(23例,采用单一锁定解剖钢板内固定治疗)。记录两组骨折复位情况、愈合情况、术后并发症发生情况以及末次随访肩关节活动范围。术后1、3、6个月及末次随访时采用Constant-Murley评分评价肩关节功能。结果患者均获得随访,时间6~19个月。骨痂开始形成时间、骨折愈合时间双钢板组均优于单钢板组(P<0.001)。Constant-Murley评分术后1、3、6个月双钢板组均优于单钢板组(P<0.001),末次随访时两组比较差异无统计学意义(P>0.05)。末次随访时,肩关节外展活动度双钢板组优于单钢板组(P<0.001),前屈、内收、后伸活动度两组比较差异均无统计学意义(P>0.05)。双钢板组术后无内固定松动或断裂等情况发生,单钢板组2例螺钉松动、1例钢板断裂、1例骨折延迟愈合。结论双钢板内固定治疗锁骨中段粉碎性骨折有利于骨折的复位及愈合,患者可早期恢复肩关节功能,疗效确切。

Objective To investigate the clinical effect of double plates internal fixation in comminuted fracture of middle clavicle.Methods The 44 patients with AO type B2 and C2 middle clavicular comminuted fractures were divided into two groups according to different internal fixation methods:double plates group(21 cases,treated with double plates internal fixation)and single plate group(23 cases,treated with single locking anatomical plate internal fixation).Fracture reduction situation,healing situation,postoperative complications and the range of motion of shoulder joint during the last follow-up were recorded.Constant-Murley score was used to evaluate shoulder function at 1,3,6 months postoperation and the last follow-up.Results All patients were followed up for 6~19 months.The time of callus formation and fracture healing in double plates group were better than those in single plate group(P<0.001).Constant-Murley scores:they were better in the double plates group than the single plate group at 1,3 and 6 months after surgery(P<0.001),and there was no significant difference between the two groups at the last follow-up(P>0.05).At the last follow-up,the double plates group was superior to the single plate group in the range of motion of the shoulder joint abduction(P<0.001),and there were no significant differences between the two groups in the shoulder range of motion of anterflexion,adduction and posterior extension(P>0.05).There was no loosening or fracture of internal fixation in the double plates group,and 2 cases of screws loosening and 1 case of plate fracture occurred in the single plate group.Conclusions The double plates internal fixation is beneficial to fracture reduction and healing and early functional rehabilitation for comminuted middle clavicle fracture,with curative effect.