交叉克氏针内固定治疗锁骨骨折65例分析

目的探讨交叉克氏针内固定治疗锁骨骨折的临床疗效。方法 65例锁骨中1/3或中外1/3处骨折病人,均用交叉克氏针内固定治疗锁骨骨折。根据骨折愈合时间、质量及肩关节功能情况综合评价疗效。结果随访时间平均为7个月,骨折愈合时间6-15周,平均7周。其中3例出现畸形愈合,无骨折不愈合。肩关节功能优55例,良7例,可3例。结论锁骨中1/3或中外1/3处骨折,用交叉克氏针内固定治疗能使病人尽快恢复功能。     

两种手术方法治疗锁骨骨折比较及相关问题探讨

目的 :比较钛镍形状记忆合金环抱式接骨板与克氏针内固定治疗锁骨骨折的疗效 ,并讨论相关问题。方法 :回顾性分析手术治疗锁骨骨折 3 6例 ,其中 16例采用钛镍形状记忆合金环抱式接骨板治疗 ,2 0例采用克氏针内固定治疗 ,比较两种方法的治疗效果。结果 :钛镍形状记忆合金环抱式接骨板内固定组手术时间平均3 5min ,术中出血平均 5 0ml。骨折平均愈合时间 3 .5个月。 16例骨折全部愈合 ,1例延迟愈合。按照韩平良等锁骨疗效标准 ,优 13例 ,良 2例 ,可l例 ,优良率 93 .7%。克氏针治疗组平均手术时间 45min ,术中出血平均 3 5ml。骨折平均愈合时间 4个月。 3例延迟愈合。优 10例 ,良 4例 ,可 6例。优良率 70 %。并发症包括感染、畸形愈合、血管神经损伤、肩关节活动受限等。两组间优良率有显著差异 (x2 =3 .90 8,P <0 .0 5 ) ,在手术时间、术中出血、骨折愈合时间无显著差异 ,在感染、骨折延迟愈合、患者不适感有显著差异 (x2 =4.5 62 ,P <0 .0 5 )。结论 :钛镍形状记忆合金环抱式接骨板在锁骨骨折内固定中的疗效优于克氏针内固定 ,是一种较好的锁骨内固定方法     

锁骨骨折4种固定治疗方法的比较

目的 比较锁骨骨折治疗方法的疗效。方法 对167例锁骨骨折的治疗方法进行回顾。结果 随诊6～18个月，平均12个月。外固定组41例，26例畸形愈合，9例延迟愈合，1例出现胸廓出口综合征。克氏针内固定组38例，3例延迟愈合，1例不愈合，4例克氏针退出，5例针尾刺破皮肤，其中3例针道有不同程度感染。钢板内固定组53例，均按预期愈合。接骨器固定组33例，均按预期愈合。结论 治疗锁骨骨折钢板与锁式接骨器的内固定治疗效果优于克氏针与外固定。     

斯氏针内固定成人锁骨骨折

目的分析无螺纹斯氏针残端留于内侧内固定成人锁骨骨折的临床效果。方法回顾分析我科自1999年12月至2004年6月148例用无螺纹斯氏针残端留于内侧内固定治疗成人锁骨骨折,其中男106例,女42例;年龄23~56岁,平均32.5岁;均为闭合性骨折。骨折部位为中外1/3,简单骨折93例(斜形骨折76例,横形骨折17例),粉碎骨折55例,于伤后1~6 d手术。结果其中140例得到随访,8例失访。其中退钉1例,气胸1例,延迟愈合1例,无感染和不愈合病例,无畸形愈合,除1例延迟愈合外均于术后6~8周X线出现骨折线模糊,8~10个月拔除内固定钉。结论无螺纹斯氏针内固定成人锁骨骨折将残端留于内侧固定可靠、选材方便、方法简单、并发症少、愈合率高,是理想的锁骨骨折内固定治疗方法。     

锁骨骨折手术112例治疗体会

目的探讨锁骨骨折手术治疗方法的选择。方法锁骨骨折112例治疗回顾。结果随诊6～15个月，平均12个月，克氏针组74例，2例延迟愈合，3例针道感染；钢板组34例，2例延迟愈合。钢丝内固定术组4例。结论应用钢板和克氏针、钢丝治疗锁骨骨折疗效无明显差异，临床上可以根据患者经济情况和骨折情况选择。     

双克氏针顺行平行固定治疗锁骨中1/3骨折

锁骨骨折通常采用非手术治疗 ,但移位明显或非手术治疗失败者常需内固定治疗。传统的手术治疗多采用单根克氏针逆行固定 ,这种方法常伴有针尾外移、针眼感染和肩关节活动受限等缺点。我院自 1998年 11月～ 2 0 0 0年 3月引用Ｃｈａｉｔｈａｖａｔ[1] 提出的双根克氏针顺行平行固定治疗锁骨中 1/3骨折 ,取得良好的效果 ,报告如下。1　资料与方法1 1　选择 32例病人 ,男 19例 ,女 13例 ;年龄 19～72岁 ,平均 36 7岁。致伤原因 :车祸 2 1例 ,摔伤 8例 ,砸伤 3例。骨折部位均为锁骨中 1/3处的新鲜闭合性骨折。1 2　方法　患者平卧 ,高位硬膜外麻…     

方尾螺纹针内固定治疗锁骨完全移位骨折(附268例报告)

目的：报道临床应用方尾螺纹针内固定治疗完全移位锁骨骨折的实践经验。材料和方法：应用方尾螺纹针治疗完全移位的锁骨骨折268例，锁骨内1／3骨折18例，中1／3者142例，外1／3者108例。结果：全部病人骨折骨性愈合，肩关节得到全方位无痛性活动，无断针、滑针和感染发生。结论：完全移位的锁骨骨折选择性地手术治疗是必要的；方尾螺针内固定安全，牢固，愈合率高，是一种好方法。     

尺骨鹰嘴骨折张力带固定219例分析

目的：观察219例尺骨座嘴骨折张力带固定的疗效。方法：对219例尺骨座嘴骨折患采用双克氏针张力带固定，结果：随访6月－2年8月，平均1年7月，本组骨折全部愈合，按Wolfgang等的后期疗效标准：良好172例，较好45例，差2例（合并肱骨髁间粉碎性骨折）。结论：尺骨鹰嘴骨折采用克氏针张力带固定牢靠，可早期功能锻炼，对骨折愈合及肘关节功能恢复有明显效果。     

钢板与克氏针治疗锁骨骨折疗效比较

目的 比较钢板与克氏针治疗锁骨骨折的疗效.方法 手术治疗锁骨骨折168例,其中钢板内固定83例,克氏针内固定85例,比较2种治疗方法在、骨折愈合时间、并发症发生率,以及疗效优良率等方面的差异.结果 术后随访4～12个月,平均7个月.钢板组骨折愈合时间18周,并发症6例,优良率92.8%.克氏针组骨折愈合时间16周,发生并发症8例,优良率90.6%.结论 钢板与克氏针治疗锁骨骨折均可取得良好的疗效.     

锁骨骨折手术治疗临床观察

目的分析、观察两种手术方法治疗不稳定锁骨骨折临床效果。方法对76例不稳定锁骨骨折分别实施克氏针或钢板内固定治疗。结果随访5～18个月，平均10个月。所有患者术中均无意外发生，无1例伤口感染及骨折不愈合。愈后优良率克氏针组85．3％；钢板组88．5％。结论克氏针或钢板内固定治疗不稳定锁骨骨折安全、有效，粉碎骨折首选采用钢板内固定。     

Hook-plate fixation of unstable lateral clavicle fractures: a report on 63 patients

Background Hook-plate fixation of unstable lateral clavicle fractures has given promising results in previous reports, but numbers of patients have been small. We assessed the results of this technique in 63 patients.

Patients and methods 63 patients with unstable lateral clavicle fractures were operated on at Oulu University Hospital during 1997-2004, using a clavicle hook-plate. Fracture union and complications were assessed retrospectively from case records and radiographs. The subjective part of the Constant score, Oxford shoulder questionnaire data and subjective shoulder value (SSV) were assessed after an average of 3.6 years in 58 patients. 31 patients were reviewed at the outpatient clinic, using complete Constant scores and radiographs of both acromioclavicular joints.

Results 59 fractures united uneventfully. There was 1 case of delayed union and 3 nonunions, but only 1 of these required surgery. Additional complications involved 1 case of infection, 1 frozen shoulder and 3 cases of late fracture medial to the plate. The mean Oxford score was 15, the mean for the subjective part of the Constant score was 32, and the SSV was 86%.

Interpretation Clavicle hook-plate fixation of unstable lateral clavicle fractures results in a good union rate and good shoulder function.     

Hook-plate fixation of unstable lateral clavicle fractures: A report on 63 patients

Background?Hook-plate fixation of unstable lateral clavicle fractures has given promising results in previous reports, but numbers of patients have been small. We assessed the results of this technique in 63 patients.

Patients and methods?63 patients with unstable lateral clavicle fractures were operated on at Oulu University Hospital during 1997–2004, using a clavicle hook-plate. Fracture union and complications were assessed retrospectively from case records and radiographs. The subjective part of the Constant score, Oxford shoulder questionnaire data and subjective shoulder value (SSV) were assessed after an average of 3.6 years in 58 patients. 31 patients were reviewed at the outpatient clinic, using complete Constant scores and radiographs of both acromioclavicular joints.

Results?59 fractures united uneventfully. There was 1 case of delayed union and 3 nonunions, but only 1 of these required surgery. Additional complications involved 1 case of infection, 1 frozen shoulder and 3 cases of late fracture medial to the plate. The mean Oxford score was 15, the mean for the subjective part of the Constant score was 32, and the SSV was 86%.

Interpretation?Clavicle hook-plate fixation of unstable lateral clavicle fractures results in a good union rate and good shoulder function.     

不修复韧带的解剖型锁定钢板治疗锁骨远端Neer Ⅱ型骨折

目的：探讨应用解剖型锁定钢板治疗NeerⅡ锁骨远端骨折的临床疗效。方法回顾性分析2012年1月至2014年6月间收治的9例NeerⅡ锁骨远端骨折患者的临床资料。其中男6例,女3例;年龄为21~61岁,平均43岁。术中所有患者均未修复喙锁韧带,应用解剖型锁定钢板内固定治疗骨折。术后定期X线检查明确骨折愈合情况,按照Neer评分标准进行肩关节功能评分。结果患者手术均顺利完成,术中无血管神经损伤,无感染、骨折不愈合等并发症发生。本组9例患者均获得随访,随访时间为6~18个月,平均12个月。骨折全部愈合,愈合时间为10~16周,平均12周。末次随访根据Neer肩关节功能评分：优5例,良3例,可1例。结论锁骨远端解剖锁定钢板内固定是治疗NeerⅡ型锁骨远端骨折的有效方法,术后肩关节疼痛及活动受限发生率低,有利于早期功能锻炼。     

Comparison of hook plate and tension band wire in the treatment of distal clavicle fractures

Tension band wire and hook plating for the treatment of distal clavicle fractures are each associated with clinical benefits and complications. In this study, we compared outcomes of 2 treatments for short-term distal clavicle fracture management for patients asking for faster improvement. From February 2005 to November 2008, 65 patients with distal clavicle fractures randomly received surgical treatment with tension band wires (n=30) or hook plates (n=35). Postoperative data including complications, radiographic union, sonographic findings and range of motion, and Oxford shoulder score at 3 and 6 months were collected and analyzed. No major operative complications occurred in either group and all patients achieved union. In the hook plate group, 9 patients experienced subacromial erosion P=.003), whereas implant dislodgement occurred in 5 patients in the tension band wire group (P=.012). Forward elevation (P=.006) and abduction (P=.004) were significantly better in the tension band wire group at 3 and 6 months postoperatively. The Oxford shoulder score was significantly better in the tension band wire group (P=.016) at 3 months postoperatively, but no different at 6 months postoperatively. We concluded that tension band wire fixation resulted in faster functional recovery than hook plate fixation for distal clavicle fractures resulting from less soft tissue dissection and injury when the tension band wire was implanted. Regardless of the implant chosen for the distal clavicle fracture, postoperative rehabilitation for the injured shoulder joint is critical for function recovery.     

解剖锁定接骨板结合改良加垫式植骨治疗锁骨骨不连疗效分析

背景：近年来,锁骨骨折接受手术治疗患者越来越多,因内固定失效致骨不连患者也渐多。国内外报道多针对锁骨骨不连的治疗方法,但在植骨方式的选择上尚存争议。目的：探讨解剖锁定接骨板结合自体骨改良加垫式植骨治疗锁骨骨不连的临床效果。方法：2006年3月至2014年8月采用切开复位解剖锁定接骨板内固定结合自体骨髂骨加垫式植骨术治疗9例锁骨中段骨不连,记录手术时间,术后随访行X线片检查观察骨折愈合情况,并采用简短肩臂手残障功能评分系统（quick-DASH）评估其功能情况,末次随访胸部正位X线片,通过对比患侧与健侧的锁骨长度评价锁骨骨不连愈合后的短缩情况。结果：9例患者的平均手术时间为（112.22±19.22）min;均获得骨性愈合,无感染、接骨板断裂及再骨折发生,平均愈合时间为（10.67±2.83）周;术后quick-DASH为（14.33±1.66）分;末次随访患侧锁骨长度较健侧平均短缩（0.27±0.09）cm,两侧锁骨长度对比无显著性差异（P〉0.05）。结论：解剖锁定接骨板结合自体骨改良加垫式植骨是治疗锁骨骨不连的一种有效方法,能有效防止锁骨短缩,恢复患肢的良好功能。     

Fractures of the distal third of the clavicle treated by hook plating

We retrospectively assessed the union and shoulder function following hook plate fixation in 18 patients with Neer type 2 fractures of the lateral end of the clavicle. The average age was 40 (range 22-62) years, and the mean follow-up was 25 (range 6-48) months. Fifteen patients had acute fractures and the rest were non-unions. Complications included two non-unions, one following a deep infection. There were no iatrogenic fractures. Acromial osteolysis was seen in five patients who had their plates in situ. The average pain score at rest was 1 (range 0-4), and the average pain score on abduction was 2.2 (range 0-5). The average Constant score was 88.5 (range 63-100). Patients were asked to rate their shoulder function; three rated it as normal, 11 as nearly normal and one as not normal. Hook plate fixation appears to be a valuable method of stabilising Neer type 2 fractures of the clavicle, resulting in high union rates and good shoulder function. These plates need to be removed after union to prevent acromial osteolysis.     

"漂浮肩"损伤手术时机对肩关节功能的影响

目的了解肩胛颈骨折并同侧锁骨骨折的手术时机是否会对肩关节功能恢复产生影响。 方法回顾性分析2016年1月至2017年12月在西安市红会医院骨显微修复外科手术治疗的肩胛颈骨折并同侧锁骨骨折患者，根据收伤后手术时机是否超过10 d分为2组。采用等级资料的非参数检验、独立样本t检验比较2组患者手术1年后肩关节活动功能情况、Herscovici功能评分，及肩关节并发症情况。 结果共纳入28例患者，早期手术组17例、延期手术组11例。2组患者手术1年后肩关节活动功能分级(Z ＝－1.715)、Herscovici功能评分(t ＝－1.286)基本一致，差异均无统计学意义(P>0.05)。随访1年，早期手术组肩关节出现外展受限1例，延期手术组肩关节外展受限2例、关节炎1例。 结论采用单纯锁骨内固定术治疗肩胛颈骨折并同侧锁骨骨折，早期或延期手术对肩关节功能恢复无明显影响。     

浮肩损伤

目的探讨浮肩损伤（floating shoulder injuries,FSI）的临床特征及治疗方法.方法回顾分析1999年6月至2005年6月收治的36例FSI的临床资料,其中肩胛颈骨折合并同侧锁骨骨折31例、肩锁关节脱位5例.患者均有不同程度的合并损伤,其中肋骨骨折、血气胸和（或）肺挫伤占88.9%.伤后至手术时间为3～43 d,平均9.6 d.术中首先复位固定锁骨骨折或肩锁关节脱位,然后采用改良Judet后方入路处理肩胛颈骨折.肩胛颈骨折合并锁骨骨折或肩锁关节脱位行一期内固定33例,术中仅固定锁骨骨折3例.结果术后随访6～69个月,平均19.7个月.肩胛颈骨折在目标区上均获解剖复位.根据Constant和Murley的疗效标准,术后肩关节功能评分为9～100分,平均81.3分,中位数为93%.按照Herscovici的疗效标准,优25例（69.4%）,良6例（16.7%）,可4例（11.1%）,差1例（2.8%）,疗效优良率为86.1%.术后复发血气胸1例,肩关节外展受限、肩峰下间隙疼痛3例,迟发性肩胛上神经损伤1例,肩关节不稳定继发创伤性关节炎1例.结论FSI使肩胛颈的解剖结构及其上方悬吊装置受到双重破坏,非手术治疗难以纠正不稳定型FSI的三维移位,早期切开复位内固定可取得满意疗效.     

Fixation of mid-third clavicular fractures with knowles pins: 78 patients followed for 2-7 years

From January 1993 to December 1997, we treated 78 (75 fresh, 1 delayed union and 2 nonunion) fractures of the mid-third clavicle with open reduction and internal fixation using 3.8 mm Knowles pins. All patients used an arm sling for 2-6 weeks after surgery, and were told to avoid vigorous exercise or work with heavy loads for the next 6 weeks. 73 fractures healed within 6 months. 3 complications occurred relating to the surgical procedures. The final rate of bone union was 77/78, although 3 patients showed a delay in bone union and 1 fracture was revised because of a loosened Knowles pin. After a mean follow-up of 49 (24-86) months, the average shoulder function, as evaluated by a modified Constant-Murley score, was 97% versus the contralateral shoulder. We suggest that if surgery is indicated, open reduction and internal fixation using a Knowles pin is an effective method for managing mid-third clavicular fractures.     

Fixation of mid-third clavicular fractures with Knowles pins: 78 patients followed for 2-7 years

From January 1993 to December 1997, we treated 78 (75 fresh, 1 delayed union and 2 non-union) fractures of the mid-third clavicle with open reduction and internal fixation using 3.8 mm Knowles pins. All patients used an arm sling for 2-6 weeks after surgery, and were told to avoid vigorous exercise or work with heavy loads for the next 6 weeks. 73 fractures healed within 6 months. 3 complications occurred relating to the surgical procedures. The final rate of bone union was 77/78, although 3 patients showed a delay in bone union and 1 fracture was revised because of a loosened Knowles pin. After a mean follow-up of 49 (24-86) months, the average shoulder function, as evaluated by a modified Constant-Murley score, was 97% versus the contralateral shoulder. We suggest that if surgery is indicated, open reduction and internal fixation using a Knowles pin is an effective method for managing mid-third clavicular fractures.