锁骨远端锁定钢板结合高强度缝线内固定治疗不稳定性锁骨远端骨折的临床疗效分析

Clinical effect analysis of internal fixation of anatomical locking plate of distal clavicle combined with high-strength suture for unstable distal clavicle fractures

目的探讨锁骨远端锁定钢板结合高强度缝线内固定治疗不稳定性锁骨远端骨折的临床疗效。方法回顾性分析2020年1月至2023年1月在我院行开放复位、锁骨远端锁定钢板结合高强度缝线固定治疗的20例不稳定性锁骨远端骨折患者的临床资料。均为闭合骨折,骨折按Neer分型:Ⅱ型17例,Ⅴ型3例;X线均示骨折块移位明显。记录患者手术时间、术中出血量、术后住院时间、骨折愈合时间及术后并发症情况,术后3个月和6个月采用Constant-Murley评分和UCLA评分评估肩关节功能恢复情况。结果20例患者手术均顺利完成,手术时间平均(57.4±8.4)min,术中出血量平均(50.3±10.6)mL,术后住院时间平均(4.0±1.8)d。本组患者均随访12个月。骨折愈合时间3~9个月,平均(4.9±2.1)个月。术后6月患者Constant-Murley评分由术前(28.5±4.4)分升至(89.8±4.4)分,UCLA肩关节评分由术前(11.5±5.6)分升至(31.0±3.6)分,差异均有统计学意义(P<0.001)。患者肩关节功能均基本恢复正常,优良率为100%。1例Ⅴ型锁骨远端骨折患者术后3个月出现无症状肩锁关节半脱位,随访12个月未见进一步脱位;1例患者术后6个月出现肩关节僵硬,经加强肩关节功能锻炼后至术后12个月完全恢复。结论采用锁骨远端锁定钢板结合高强度缝线固定治疗不稳定性锁骨远端骨折可实现解剖复位和稳定固定,促进骨折愈合,患者术后肩关节功能恢复良好,并发症少,值得临床推广应用。

Objective To investigate the clinical efficacy of internal fixation of anatomical locking plate of distal clavicle combined with high-strength suture for the treatment of unstable distal clavicle fractures.Methods The clinical data of 20 cases with unstable closed distal clavicle fractures performed open reduction and internal fixation with anatomical locking plate and high-strength sutures from January 2020 to January 2023 were retrospectively analyzed.There were typeⅡin 17 cases and type V in 3 cases according to Neer classification of fracture.X-ray showed obvious displacement of fracture fragments in all 18 cases.The operation time,intraoperative blood loss,postoperative hospitalization time,fracture healing time and postoperative complication were recorded,and shoulder function was evaluated by the Constant-Murley score and the University of California Los Angeles(UCLA)score at 3 and 6 months postoperatively.Results The operations were completed successfully in all 20 cases,with the mean operation time of(57.4±8.4)minutes,the mean intraoperative blood loss of(50.3±10.6)mL and the mean postoperative hospital stays of(4.0±1.8)days.All cases were followed up for 12 months.Fractures achieved healing during 3 to 9 months with an average of(4.9±2.1)months.The Constant-Murley score was improved from 28.5±4.4 preoperatively to 89.8±4.4 postoperatively,the UCLA score was from 11.5±5.6 preoperatively to 31.0±3.6 postoperatively,and all differences were significant(P<0.001).Shoulder function was nearly restored to normal in all cases,with the fineness rate of 100%.Asymptomatic acromioclavicular joint subluxation was found in one patient with distal clavicle fracture of type V at 3 months after the operation,and no dislocation progression was observed during 12 months of follow-up.Shoulder stiffness occurred in one case at 6 months after the operation,and recovered completely at 12 months after functional exercise.Conclusion The method of internal fixation of anatomical locking plate of distal clavicle combined with high-strength suture can achieve anatomical reduction and stable fixation,promote fracture healing,restore satisfactory shoulder function for unstable distal clavicle fractures with few complications,and it is worthy of clinical application.