锁骨钩接骨板治疗锁骨外侧端骨折及肩锁关节脱位2年随访分析

Therapeutic effect of clavicular hook plate on distal clavicular fracture or acromioclavicular joint dislocation: a two-year follow-up

背景:锁骨外侧端骨折及肩锁关节脱位多主张早期手术治疗,锁骨钩接骨板内固定术是应用较多的一种手术方式,近期疗效肯定,但中远期疗效尚不确切。目的目的:探讨锁骨钩接骨板内固定术治疗锁骨外侧端骨折及肩锁关节脱位的中期疗效和并发症情况。方法方法:选取2008年2月至2011年7月采用肩锁钩接骨板内固定术治疗的37例锁骨外侧端骨折患者(A组)及32例肩锁关节脱位患者(B组),术中视情况选择钢丝捆扎及韧带修复,术后随访2年,进行Constant-Murley评分,观察并发症发生情况,并进行统计学分析。结果结果:所有患者获得随访,术后3个月Constant-Murley评分优良率A组为83.78%(31/37),B组为84.38%(27/32),相比较有无统计学差异(P=0.067);术后2年Constant-Murley评分优良率A组为86.49%(32/37),B组为93.75%(30/32),相比较有统计学差异(P=0.034)。并发症发生率A组为18.92%(7/37),B组为15.63%(5/32),相比较无统计学差异(P=0.719)。在发生并发症的12例患者中原有肩锁关节骨化10例,其中A组6例,B组4例;原有肩锁关节骨关节病5例,其中A组3例,B组2例,并发症的发生情况与原有病变呈正相关(P=0.206)。结论结论:肩锁钩接骨板内固定术治疗锁骨外侧端骨折和肩锁关节脱位的效果良好,后者的疗效更优。两者的并发症发生情况与原有肩锁关节骨化和骨关节病呈正相关,但具体机制还有待进一步研究。

Background: The distal clavicle fractures and acromioclavicular joint dislocation commonly demands surgery. Clavicular hook plate fixation is applied effectively and frequently, but long-term effectiveness has not been confirmed.Objective: To investigate therapeutic effect and complications of clavicular hook plate fixation in treatment of distal clavicle fracture or acromioclavicular dislocation.Methods: In this retrospective study, 37 patients with distal clavicle fracture(group A) and 32 patients with dislocation of acromioclavicular joint(group B) were treated by using clavicular hook plate fixation between February 2008 and July 2011.All the patients were followed up for 2 years. Constant-Murley score and complications were recorded.Results: The excellent and good rate of Constant-Murley score was 83.78%(31/37) in group A and 84.38%(27/32) in group B(P=0.067) 3 months after surgery. The excellent and good rate of Constant-Murley score was 86.49%(32/37) in group A and 93.75%(30/32) in group B(P=0.034) 2 years after surgery. The incidence of complications was 18.92%(7/37) in group A and15.63%(5/32) in group B(PP=0.719). In 12 patients suffering from postoperative complications, there were 10 with primary acromioclavicular joint ossification(6 in group A and 4 in group B), 5 with original acromioclavicular joint osteoarthritis(3 in group A and 2 in group B). Postoperative complications was positively correlated with primary disease(P=0.206).Conclusions: Clavicular hook plate is an effective surgical treatment for distal clavicular fracture and acromioclavicular joint dislocation. The therapeutic effect for the latter is superior to the former. Postoperative complications is positively correlated to primary acromioclavicular joint ossification and osteoarthritis, and the mechanism need to be studied further.