锁骨钩钢板内固定治疗锁骨远端骨折并发症分析

目的分析锁骨钩钢板内固定治疗锁骨远端骨折时并发症发生的原因,探讨减少并发症、提高临床疗效的方法。方法回顾性分析锁骨远端骨折25例行锁骨钩板内固定术后的疗效及并发症情况。结果患者均获得随访,所有骨折均愈合良好,术后早期和内置物取出术后患者肩关节功能恢复均较满意。结论锁骨钩钢板治疗移位锁骨远端骨折虽有一定的并发症发生率,但钩钢板取出后表现为疼痛不适等现象均明显缓解。     

双带襻钢板与锁骨钩钢板治疗锁骨远端骨折的比较

目的比较双带襻钢板与锁骨钩钢板置入治疗锁骨远端NeerⅡ型骨折的疗效。方法对2011年1月至2013年12月收治的38例NeerⅡ型锁骨远端骨折患者进行病例对照研究,18例应用双带襻钢板技术治疗,20例应用锁骨钩钢板治疗。术前两组患者一般资料具有可比性。分别对两组患者术中及住院期间的各项指标、术后疼痛视觉模拟评分(visual analogue scale,VAS)、美国肩与肘协会评分系统(American shoulder and elbow surgeons evaluation form,ASES)及并发症进行比较分析。结果锁骨钩钢板组与带襻钢板组相比手术时间短、术中出血量少、治疗费用少,但后者术后在肩关节活动时疼痛感、肩关节功能上明显好于前者,且后者无需取出内固定材料。在是否发生骨折、内固定物断裂、松动及切口感染等并发症方面两组差异无统计学意义。带襻钢板组有1例发生骨折端再移位。锁骨钩钢板取出后,两组患者在疼痛、肩关节功能上无明显差异。结论双带襻钢板技术治疗NeerⅡ型锁骨远端骨折近期疗效优于锁骨钩钢板,远期疗效无明显差异。     

比较锁骨远端解剖锁定钢板与锁骨钩钢板治疗NeerⅡ型锁骨远端骨折的疗效

目的比较锁骨远端解剖锁定钢板与锁骨钩钢板治疗NeerⅡ型锁骨远端骨折的临床效果。方法回顾性分析2018-10—2020-01间漯河医学高等专科学校第二附属医院骨科行内固定手术治疗的62例NeerⅡ型锁骨远端骨折患者的临床资料,根据内固定方式不同分为锁骨远端解剖锁定钢板组(锁定钢板组,32例)和锁骨钩钢板组(30例)。对2组患者的基线资料、手术治疗及术后恢复等指标进行比较。术后3个月、6个月时采用Constant-Murley评分标准评价治疗效果。结果2组患者的基线资料、手术时间及术中出血量等比较,差异均无统计学意义(P>0.05)。锁定钢板组术后并发症发生率低于锁骨钩钢板组,术后3个月、6个月时Constant-Murley评分高于锁骨钩钢板组,差异均有统计学意义(P<0.05)。结论与锁骨钩钢板相比,采用锁骨远端解剖锁定钢板治疗NeerⅡ型锁骨远端骨折,术后并发症少,治疗效果更为确切。     

肩锁关节周围损伤锁骨钩钢板内固定术后肩痛的原因分析

目的探讨锁骨远端端骨折与肩锁关节脱位患者锁骨钩钢板内固定术后肩痛的原因,并提出应对策略。方法回顾性分析自2008-03—2016-03采用锁骨钩钢板内固定治疗的60例NeerⅡ锁骨远端骨折和40例RockwoodⅢ~Ⅵ型肩锁关节脱位。采用Spearman相关性分析术后肩痛与性别、年龄、VAS评分、损伤类型、钢板放置位置、术后并发症的相关性。结果 100例均获得随访3~12(10.50±2.44)个月。末次随访时12例疼痛不缓解,其中钢板放置不佳5例,感染2例,脱钩2例,骨折不愈合1例,2例无明确原因。通过Spearman相关性分析发现,术后疼痛与钢板放置位置(r=0.408,P0.001)及术后并发症(r=0.501,P0.001)相关,而与性别(r=-0.145,P=0.223)、年龄(r=-0.089,P=0.504)、损伤类型(r=-0.132,P=0.286)、VAS评分(r=-0.156,P=0.208)无关。结论锁骨钩钢板内固定治疗锁骨远端骨折与肩锁关节脱位术后患者疼痛与钢板放置位置及术后并发症明显相关,术前应根据相关的测量数据选择长度和钩深度合适的锁骨钩钢板,并预判钩在肩峰下的最佳安放位置,术后于合适的时机取出内固定并早期进行功能锻炼。     

锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位38例

目的观察研究锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位的疗效。方法对2004年3月至今我院共收治38例锁骨远端骨折和肩锁关节脱位用锁骨钩钢板手术治疗,术后随访3~18个月。结果对38例患者均进行随访,术后X线片均见愈合良好。但术后发生肩周轻度疼痛4例,肩关节活动受限1例。结论锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位创伤小,固定牢固,疗效好,值得推广。     

锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位

目的探讨锁骨钩钢板在锁骨远端骨折和肩锁关节脱位中的治疗效果。方法对56例锁骨远端骨折和肩锁关节脱位患者行切开复位锁骨钩钢板内固定术。结果伤口感染2例,经换药愈合。56例均获随访,时间4～16个月。内固定松动及脱出3例,锁骨中段骨折1例,锁骨钩钢板锁骨钩不在肩峰下1例,均经石膏固定愈合;X线片显示锁骨骨折全部愈合,肩锁关节无再脱位发生。按照Karlsson评价标准：优40例,良11例,差5例,优良率91.1%。结论锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位创伤小、固定牢固、能早期活动肩关节,是治疗锁骨远端骨折和肩锁关节脱位有效的方法。     

锁骨钩钢板固定治疗锁骨远端骨折患者的康复护理

目的探讨锁骨钩钢板治疗锁骨远端骨折患者术后的康复护理方法。方法对15例锁骨远端骨折患者实施锁骨钩钢板固定术治疗，术后给予康复护理，如挺胸提肩、康复训练及出院指导等；观察患者骨折愈合情况。结果15例患者经过治疗及康复护理、观察及随访，骨折全部愈合。结论锁骨钩钢板治疗锁骨远端骨折及术后计划性、系统性的康复护理，具有固定牢靠，恢复快等优点。     

锁骨钩钢板固定治疗锁骨远端骨折患者的康复护理

目的 探讨锁骨钩钢板治疗锁骨远端骨折患者术后的康复护理方法.方法 对15例锁骨远端骨折患者实施锁骨钩钢板固定术治疗,术后给予康复护理,如挺胸提肩、康复训练及出院指导等;观察患者骨折愈合情况.结果 15例患者经过治疗及康复护理、观察及随访,骨折全部愈合.结论 锁骨钩钢板治疗锁骨远端骨折及术后计划性、系统性的康复护理,具有固定牢靠,恢复快等优点.     

锁骨钩钢板在锁骨远端创伤的应用及并发症分析

目的：探讨应用锁骨钩钢板内固定治疗锁骨远端创伤患者的临床效果,分析并发症的原因并探讨进一步防治措施。方法：2001年9月至2008年2月治疗50例锁骨远端创伤患者,其中男36例,女14例;年龄19～77岁,平均43岁。新鲜NeerⅡ型锁骨远端骨折36例,TossyⅢ型肩锁关节脱位14例。应用锁骨钩钢板内固定治疗。术后随访测量肩关节前屈上攀活动度和并发症发生情况,分别采用Karlsson标准及Constant—Murley评分标准进行功能评价。结果：所有患者随访7～18个月,平均12个月,术后1周所有患者均能进行肩关节主动活动。术后6周均完全恢复日常生活和工作能力。按照Karlsson标准,优44例,良6例。对患肩进行Constant—Murley评分,术前患肩平均（73．8&#177;8．3）分,术后平均（59．6&#177;6．7）分,术后评分高于术前。无伤口感染发生,5例发生术后并发症均得到及时治疗,随访骨折全部愈合,无肩锁关节再次脱位。结论：应用锁骨钩钢板内固定治疗NeerⅡ型锁骨远端骨折和TossyⅢ型肩锁关节脱位,具有固定坚强可靠、能早期功能锻炼的优点,同时又能减少手术并发症。     

锁骨钩钢板治疗锁骨远端骨折

目的 探讨AO锁骨钩钢板治疗锁骨远端骨折的疗效。方法 2001年5月～2003年5月，采用AO锁骨钩钢板治疗14例急性锁骨远端骨折（NeerⅡ型)的患者。结果 14例患者均取得满意的效果，无切口感染、内固定失效、骨折不愈合等并发症。结论 AO锁骨钩钢板是治疗锁骨远端骨折的较理想的方法。     

锁骨钩钢板内固定术后钢板钩与肩峰匹配性影像学研究

目的通过测量锁骨钩钢板内固定术后患者影像学资料，分析发生肩峰骨侵蚀的原因是否与钢板钩-肩峰匹配度相关。 方法回顾性分析2015年8月1日至2018年8月31日期间在上海市浦东医院骨科就诊的210例患者的影像学资料，210例患者均因肩锁关节脱位或锁骨远端骨折行锁骨钩钢板内固定治疗，其中男110例、女100例；年龄24~76岁，平均（44.60±8.75）岁；肩锁关节脱位70例，锁骨远端骨折140例。测量术后及终末随访患者肩锁关节正位X线片相关数据，按锁骨钩钢板术后是否发生肩峰骨侵蚀，将纳入患者分为3组：无骨侵蚀组（A组）、伴钢板钩移位骨侵蚀组（B组）、不伴移位的骨侵蚀组（C组），分别测量钢板钩-肩峰的匹配度（β），统计分析术后发生肩峰骨侵蚀与钢板钩-肩峰匹配度之间的关系。 结果纳入研究的210例患者术后随访24~64周，平均（32.0±6.5）周。A组患者115例，B组患者54例，C组患者41例。A组匹配度β（3.72±0.48）mm与B组β¹（6.91±0.84）mm比较差异有统计学意义（P<0.05）；A组匹配度β（3.72±0.48）mm与C组β²（5.88±0.65）mm比较差异有统计学意义（P<0.05）；B组匹配度β¹（6.91±0.84）mm与C组β²（5.88±0.65）mm比较差异有统计学意义（P<0.05）。 结论锁骨钩钢板内固定术后是否发生肩峰骨侵蚀与钢板钩-肩峰匹配度β存在明显相关性，钢板钩与肩峰之间的匹配度越好，β值越小，发生肩峰骨侵蚀的可能性更小。     

锁骨钩钢板治疗锁骨远端骨折脱位的并发症分析

目的：探讨锁骨钩钢板治疗TossyⅢ型肩锁关节脱位和NeerⅡ型锁骨远端骨折术后并发症的原因及其防治方法。方法：2001年1月至2011年12月,采用锁骨钩钢板分别治疗TossyⅢ型肩锁关节脱位246例和NeerⅡ型锁骨远端骨折222例。其中男348例,女120例;年龄21～80岁,平均45．4岁;受伤至手术时间1h-15d,平均30．8h。所有患者受伤前肩关节活动正常。根据Karlsson评定标准,将肩关节功能恢复优良者归为正常组、肩关节功能差者为异常组,对两组肩关节的前屈、后伸、内收、外展和上举进行比较,总结钢板钩撞击肩峰、肩峰下骨质磨损、肩锁关节炎、锁骨应力骨折、肩锁关节向下半脱位、脱钩和断钩的情况。结果：468例均获随访,时间8-48个月,平均12．5个月。按照Karlsson评定标准,优308例,良76例,差84例。两组肩关节前屈、后伸、内收、外展和上举的差异均有统计学意义（P〈0．01）。异常组患者中,41例（8．76％）钢板钩撞击肩峰或位置不佳,12例（2．56％）肩峰下骨质磨损或肩峰下滑囊炎,10例（2．14％）肩锁关节炎和锻炼太晚引起肩痛不适,7例（1．50％）锁骨应力性骨折或钢板内侧端翘起,6例（1．28％）肩锁关节向下半脱位,5例（1．07％）脱钩,3例（0．64％）断钩。结论：锁骨钩钢板是治疗Tossym型肩锁关节脱位和NeerⅡ型锁骨远端骨折的较好方法,术中正确放置钢板钩的位置、适当将钢板钩预弯、修复肩锁关节周围纤维结构以及合理功能锻炼有助于减少并发症的发生。     

Surgical treatment of unstable fractures of the distal clavicle: A comparative study of Kirschner wire and clavicular hook plate fixation

During 1988-1999 39 unstable fractures of the distal clavicle (Neer 2) were operated on in Oulu University Hospital. Kirschner wire (K-wire) fixation was used in 22 cases and a clavicular hook plate in 17. Shoulder symptoms and function were assessed using self-administered questionnaires devised by L'Insalata et al. (1997), and Constant scoring. Mean follow-up was 6.2 years in the K-wire fixation group and 2.0 years in the clavicular hook plate one. The mean L'Insalata scores were 91 in both groups (92% and 93% of the contralateral side) and the mean Constant scores 84 (95%) and 90 (96%) for K-wire fixation and the clavicular hook plate, respectively. Complications commonly occurred with K-wires, which migrated in 12 cases, resulting in loss of reduction in 7 and infection in 3, and 2 cases of non-union. In the clavicular hook plate group, there was 1 complication, a fracture of the clavicle, and 2 cases of non-union. We conclude that shoulder symptoms were reduced and function restored to an adequate level by both methods, but complications were unacceptably frequent when K-wires were used. The clavicular hook plate was better in this respect and it is therefore recommended.     

Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation

During 1988-1999 39 unstable fractures of the distal clavicle (Neer 2) were operated on in Oulu University Hospital. Kirschner wire (K-wire) fixation was used in 22 cases and a clavicular hook plate in 17. Shoulder symptoms and function were assessed using self-administered questionnaires devised by L'Insalata et al. (1997), and Constant scoring. Mean follow-up was 6.2 years in the K-wire fixation group and 2.0 years in the clavicular hook plate one. The mean L'Insalata scores were 91 in both groups (92% and 93% of the contralateral side) and the mean Constant scores 84 (95% and 90 (96%) for K-wire fixation and the clavicular hook plate, respectively. Complications commonly occurred with K-wires, which migrated in 12 cases, resulting in loss of reduction in 7 and infection in 3, and 2 cases of non-union. In the clavicular hook plate group, there was 1 complication, a fracture of the clavicle, and 2 cases of non-union. We conclude that shoulder symptoms were reduced and function restored to an adequate level by both methods, but complications were unacceptably frequent when K-wires were used. The clavicular hook plate was better in this respect and it is therefore recommended.     

Clinical Results of Treatment Using a Clavicular Hook Plate Versus a T-plate in Neer Type II Distal Clavicle Fractures

AO clavicular hook plate fixation provides more rigid fixation and good bony union rates for Neer type II distal clavicular fractures. However, the hook may cause rotator cuff tears and subacromial impingement, which adversely affect the clinical results. T-plate fixation is another surgical method of treatment for unstable clavicle fractures, and its clinical efficacy has been demonstrated. The purpose of this study was to compare the clinical outcomes of AO clavicular hook plate and T-plate fixation for Neer type II distal clavicular fractures.Forty-two patients with Neer type II fractures were divided into 2 groups. The hook plate group comprised 23 patients who underwent hook plate fixation, and the T-plate group comprised 19 patients who underwent distal radius volar locking T-plate fixation. Hook plates were removed 3 to 14 months postoperatively in 15 patients because of shoulder function limitations. All patients were evaluated postoperatively for shoulder pain, activities of daily living, range of motion, strength, and satisfaction according to the University of California, Los Angeles (UCLA) Shoulder rating scale. All fractures in the 2 groups achieved stable fixation and bony union. Both groups yielded similar outcomes with regard to shoulder strength and patient satisfaction (P=.207 and P=.398, respectively). Significant differences existed between the 2 groups in the mean scores of shoulder pain, activities of daily living, range of motion, and total UCLA score (P=.001, P=.011, P=.038, and P=.001, respectively). More patients (74%) in the hook plate group had mild to severe shoulder pain than in the T-plate group (16%). However, shoulder pain was relieved and function improved significantly after removal of the hook plate (P=.001).     

Comparison of the efficacy of a distal clavicular locking plate versus a clavicular hook plate in the treatment of unstable distal clavicle fractures and a systematic literature review

Purpose

The purpose of this study was to retrospectively compare and review the clinical outcomes between the distal clavicular locking plate and clavicular hook plates in the treatment of unstable distal clavicle fractures; moreover, the relevant literature of the two fixation methods was reviewed systematically to identify the non-union, complications, or functional scores, according to the treatment methods and determine which treatment method is better.

Methods

Sixty-six patients with 66 unstable distal clavicle fractures who underwent open reduction and internal fixation with either a distal clavicular locking plate (36 patients) or a clavicular hook plate (30 patients ) were evaluated. The main outcome comparisons included Constant score, rate of non-union, rate of complication, and rate of returning to work three months postoperatively.

Results

No significant difference was found between locking plate and hook plate groups in union rate and Constant score (P > 0.05). However, the results indicated that the distal clavicular locking plate group had a significantly lower rate of complications (P < 0.05) and symptomatic hardware (P < 0.05). In addition, the distal clavicular locking plate facilitated the return to work better than the clavicular hook plate (P < 0.05).

Conclusions

Both distal clavicular locking plate and clavicular hook plate achieved good results in the treatment of unstable distal clavicle fractures; however, internal fixation with a distal clavicular locking plate had greater ability to return to their previous work after surgery in three months and fewer complications than the clavicular hook plate.     

不同方法治疗锁骨骨折的疗效分析

目的探讨锁骨骨折的治疗方式。方法94例锁骨骨折患者分别采用手术治疗和保守治疗。男73例,女21例。年龄14～65岁,平均35．4岁。手术治疗64例,包括克氏针内固定18例,重建钢板固定20例,锁骨锁定钢板16例,锁骨钩钢板固定10例。保守治疗30例。结果采用3种钢板固定法的患者的生活质量明显高于单独克氏针内针固定者;保守治疗对于移位较轻或复位后较稳定的骨折具有良好的疗效。结论钢板内固定具有良好的临床疗效,而锁骨骨折的治疗仍应根据不同患者的具体情况进行分析,选择合适的治疗方法。     

Risk factors for nonunion in 337 displaced midshaft clavicular fractures treated with Knowles pin fixation

Background

Clavicular fractures account for nearly 10 % of all fractures, and the majority of those fractures involve the midshaft. Historically, these fractures were treated nonoperatively; however, recent data suggest an increased risk of nonunion and symptomatic malunion for displaced, comminuted midshaft clavicular fractures treated conservatively. Surgical intervention via plate osteosynthesis or intramedullary fixation with pins, nails, or screws has been shown to reduce, but not eliminate, this risk. Identification of risk factors predictive of nonunion would improve the overall management of displaced, comminuted midshaft clavicular fractures.

Methods

The medical records of 337 consecutive patients who underwent Knowles pin fixation and supplemental cerclage for the treatment of displaced, comminuted midshaft clavicular fractures between April 2007 and March 2009 were retrospectively reviewed. The records of the mechanism of injury, side of injury, Robinson fracture classification, presence of associated injuries, cerclage material, and patient-related variables, including diabetes mellitus, hypertension and smoking, were analyzed. Variables were assessed by univariate and multivariate analysis to identify those factors significantly associated with the development of fracture nonunion.

Results

A total of 19 nonunions occurred. Increasing age and use of wire for supplemental cerclage fixation were significantly associated with an increased risk for fracture nonunion (p < 0.001). Although suggested as predictors of nonunion in other studies, female gender and fracture severity were not significantly associated with nonunion.

Conclusions

Nonunion remains a significant complication in the treatment of displaced, comminuted midshaft clavicular fractures even with intramedullary fixation. Use of absorbable suture in place of wire for cerclage fixation and careful selection of treatment strategy in the elderly may reduce the risk for nonunion.     

钩钢板和解剖锁定板治疗锁骨远端NeerⅡ型骨折的疗效比较

目的比较解剖锁定板和钩钢板治疗锁骨远端NearⅡ型骨折的疗效。方法对32例锁骨远端NeerⅡ型骨折患者分别采用解剖锁定板固定(18例)和钩钢板固定(14例)。结果患者均获得随访,时间9~20个月。患者骨折均愈合,无伤口感染、内固定失效等并发症发生。钩钢板组出现2例肩关节疼痛、外展受限,3例肩峰下骨侵蚀,于术后6~8个月取出内固定物,肩关节疼痛逐渐缓解,功能恢复良好。术后3、6个月解剖锁定板组肩关节功能优于钩钢板组(P0.01),内固定物取出后3个月,两组肩关节功能比较差异无统计学意义(P0.05)。结论解剖锁定板和钩钢板都是治疗锁骨远端NeerⅡ型骨折的有效方法,应根据不同的骨折选择合适的内固定物。