三种不同内固定方式治疗锁骨远端骨折的疗效比较

目的比较三种内固定方式治疗锁骨远端的临床疗效,以期指导临床合理选择和应用。方法回顾性分析2011年1月—2013年5月东营市人民医院采用锁骨远端解剖型钢板内固定(A组)、锁骨钩钢板内固定(B组)和双钢板垂直内固定(C组)三种方法治疗63例锁骨远端粉碎性骨折患者,其中A组18例,CraigⅡ类Ⅱ型15例,Ⅱ类V型3例;B组24例,CraigⅡ类Ⅱ型20例,Ⅱ类V型4例;C组21例,CraigⅡ类Ⅱ型18例,Ⅱ类V型3例。采用Constant-Murley评分系统评价肩关节功能,并对三组患者的骨折愈合时间、术后并发症发生情况等进行对比分析。结果 63例患者术后获13~19个月(平均17.2个月)随访。三组患者肩关节Constant-Murley评分优良率分别为94.4%、75.0%、90.5%,A组、C组明显优于B组,差异均有统计学意义(P0.001)。B组术后并发症发生率为16.7%,明显高于A组(0)和C组(4.8%),差异有统计学意义(P0.05)。结论三种内固定技术治疗锁骨远端骨折均可获得较好的临床效果,锁骨远端解剖型钢板及双钢板垂直内固定术后肩关节疼痛及肩关节活动受限发生率更低。

A comparative study of three internal fixation methods for distal clavicle fractures

Objective To explore clinical and radiographic outcomes of three internal fixation methods in treatment of distal clavicle fractures.Methods Data of 63 patients with distal clavicle fracture were retrospectively analyzed,who were admitted to our department from Jan.2011 to May 2013.Among them,18 patients were treated with distal clavicular anatomical plate(group A),24 patients were treated with clavicular hook plate(group B),and 21 patients were treated with double mini-plate(group C).According to Craig classification of fractures,there were 15 patients with Craig Ⅱ/type Ⅱ and 3 with Craig Ⅱ/type V in Group A;20 with Craig Ⅱ/type Ⅱ and 4 with Craig Ⅱ/type V in Group B;18 with CraigⅡ/typeⅡand 3 with CraigⅡ/type V in Group C.The general preoper-ative data of the three groups were comparable.The functional recovery of the shoulder joint was assessed using the American Shoulder and Elbow Surgeons(ASES)rating scale score.A retrospective study was performed to compare the outcomes of the 3 methods regarding bone union and complications.Results The patients were followed up for 13 to 19 months(average,17.2 months).According to the Constant-Murley evaluation standard,the excellence rates of the three groups were 94.4%,75.0%,90.5%,respectively,which was higher in groups A and C than group B (P<0.001).The rate of complication in group B was 16.7%,which was significantly higher than that in group A (0)and group C(4.8%),with statistical difference among the three groups(P<0.05).Conclusion All three internal fixation techniques can attain good clinical outcomes in treatment of distal clavicle fractures.The distal cla-vicular anatomical plate fixation and double mini-plate fixation can effectively decrease the incidence of shoulder pain,and greatly reduce the incidence of limited shoulder movement.