基于三维CT的锁骨中段骨折改良Robinson分型及临床治疗方案

Improved Robinson classification and clinical treatment of midshaft clavicle fracture based on three-dimensional CT

目的探讨利用术前三维CT对锁骨中段骨折进行改良Robinson分型及临床治疗方法.方法我科自2016年3月至2020年12月收治锁骨中段骨折患者150例.参照Robinson分型,结合临床治疗方案的选择,归纳出改良Robinson分型,共分为三型五个亚型:2A型4例,锁骨中段简单骨折,移位<100%;2B1型31例,简单骨折,包括横形、斜形、螺旋形,骨折移位>100%;2B2型64例,粉碎骨折,远近端骨折断端有皮质接触,断端骨块数量≥1;2B3型29例,2B1、2型骨折,骨折线累及至锁骨远端折角处锁骨锥形结节平面;2C1型19例,远近端骨折断端无骨皮质接触,断端骨块粉碎;2C2型3例,节段性骨折,中间骨块完整.手术方案:99例2A~B2型患者中,37例采用弹性钉内固定,62例采用钢板内固定;2B3~C2型全部选择钢板内固定.根据骨折分型及临床治疗方案的选择进行分析.结果术后随访2A~B2型患者中,弹性钉固定及钢板固定两组术后肩关节Constant评分及DASH评分、并发症发生率比较,差异均无统计学意义(P>0.05).弹性钉组手术切口长度比钢板组明显短,术后瘢痕美观度较高,且二次手术取出内固定手术切口仅1 cm.结论根据改良Robinson分型可指导手术方案,对于2A~2B2型患者,微创弹性钉内固定术后瘢痕美观度较高,功能恢复满意,而对于2B3~C2型患者仍首选钢板内固定.

Objective To investigate the use of preoperative three-dimensional CT for improved Robinson classification and clinical treatment of midshaft clavicle fractures.Methods From March 2016 to December 2020,150 patients with midshaft clavicle fractures were treated.Referring to Robinson classification and combining with the selection of clinical treatment plans,an improved Robinson classification was summarized,which could be divided into three types and five subtypes:4 cases of type 2A,simple fracture of the middle clavicle,displacement<100%;31 cases of type 2B1,simple fractures,including transverse,oblique,and spiral,with fracture displacement>100%;64 cases of type 2B2,comminuted fracture,with cortical contact at the distal and proximal ends of the fracture,and a total of≥1 bone block at the fracture end;29 cases of type 2B3,type 2B1 and type 2 fractures,with the fracture line extending to the plane of the conical tuberosity of the clavicle at the distal angle of the clavicle;19 cases of type 2C1,with no cortical contact at the distal and proximal ends of the fracture,and comminuted bone fragments at the fracture ends;3 cases of type 2C2,with segmental fractures and intact intermediate bone fragments.Among 99 patients with type 2A to B2,37 cases were treated with elastic nail internal fixation and 62 cases were treated with plate internal fixation.All types 2B3 to C2 were fixed internally with plates.Based on the classification of fractures and the selection of clinical treatment plans,the analysis was conducted.Results In postoperative follow-up of patients with type 2A to B2,there was no statistically significant difference in the postoperative shoulder Constant score,DASH score,and incidence of complications between the two groups of elastic nail fixation and plate fixation(P>0.05).The length of the surgical incision in the elastic nail group was significantly shorter than that in the plate group,and the postoperative scar aesthetics were higher.In addition,the surgical incision with internal fixation removed during the secondary surgery was only 1 cm.Conclusion According to the improved Robinson classification,surgical plans can be guided.For patients with type 2A to 2B2,minimally invasive elastic nail internal fixation has a higher degree of scar aesthetics and satisfactory functional recovery,while for patients with type 2B3 to C2,plate internal fixation is still preferred.