克氏针与锁骨钩钢板内固定治疗大龄儿童锁骨远端骨折的疗效比较

Comparison of Kirschner wire and clavicular hook plate in the treatment of distal clavicle fractures in older children

目的比较克氏针与锁骨钩钢板内固定治疗儿童锁骨远端骨折的疗效。方法回顾性分析2014年12月至2023年12月期间在福州市第二总医院小儿骨科接受手术治疗的28例儿童锁骨远端骨折患者资料。男20例,女8例;年龄10.0(9.0,12.8)岁;左侧22例,右侧6例;Craig修订的骨折Neer分型:Ⅱ型22例,Ⅳ型5例,Ⅴ型1例。根据内固定方式不同分为2组:克氏针组(12例采用切开复位克氏针内固定术)和钩钢板组(16例采用切开复位锁骨钩钢板内固定术)。记录并比较两组患者的手术时间、住院时间、骨折愈合时间、并发症发生情况及末次随访时Constant-Murley肩关节功能评分、简易版上肢功能评分(quickDASH)及外观满意度视觉模拟评分(VAS)。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。术后28例患者获(14.8±6.5)个月随访。克氏针组患者手术时间[(34.3±12.1)min]显著短于钩钢板组[(49.4±16.8)min],末次随访时患者外观满意度VAS评分[(8.2±1.1)分]显著高于钩钢板组[(6.2±2.6)分],差异均有统计学意义(P<0.05)。克氏针组与钩钢板组患者住院时间、骨折愈合时间、并发症发生情况及末次随访时Constant-Murley评分、quickDASH评分比较差异均无统计学意义(P>0.05)。结论对于儿童锁骨远端骨折患者而言,克氏针与锁骨钩钢板内固定术后均可获得良好的功能,但克氏针内固定手术时间较短、术后患者外观满意度更高且无需二次手术取内固定物。

ObjectiveTo compare the efficacy between Kirschner wire and clavicular hook plate in the fixation of distal clavicle fractures in older children.MethodsA retrospective analysis was conducted of the 28 pediatric patients with distal clavicle fracture who had undergone surgical treatment at Department of Pediatric Orthopedics,The Second General Hospital of Fuzhou from December 2014 to December 2023.There were 20 boys and 8 girls.Age:10.0(9.0,12.8)years old;22 left sides and 6 right sides;by the Craig modified Neer classification:22 cases of typeⅡ,5 cases of typeⅣ,and 1 case of typeⅤ.The patients were divided into 2 groups based on their internal fixation methods.The Kirschner wire group of 12 cases were treated with open reduction and Kirschner wire fixation;the hook plate group of 16 cases were treated with open reduction and clavicular hook plate fixation.Operation time,hospital stay,fracture healing time,incidence of complications,and scores at the final follow-up(the Constant-Murley shoulder function score,quick disabilities of the arm,shoulder,and hand(quickDASH)score,and visual analog scale(VAS)for aesthetic satisfaction)were recorded and compared between the 2 groups.ResultsThere were no statistically significant differences in the baseline data between the 2 groups,indicating comparability(P>0.05).The postoperative follow-up period for the 28 patients was(14.8±6.5)months.The operation time in the Kirschner wire group[(34.3±12.1)min]was significantly shorter than that in the hook plate group[(49.4±16.8)min](P<0.05),and the VAS score for aesthetic satisfaction at the final follow-up in the Kirschner wire group[(8.2±1.1)points]was significantly higher than that in the hook plate group[(6.2±2.6)points](P<0.05).There were no statistically significant differences between the 2 groups in terms of fracture healing time,hospital stay,incidence of complications,or Constant-Murley score and quickDASH score at the final follow-up(P>0.05).ConclusionsFor pediatric patients with distal clavicle fracture,both Kirschner wire fixation and clavicular hook plate fixation can achieve good functional outcomes.However,Kirschner wire fixation has advantages of shorter operation time,higher postoperative aesthetic satisfaction,and no need of a secondary surgery for implant removal.