双钢板内固定治疗锁骨远端粉碎性骨折临床疗效

目的探讨双钢板内固定治疗锁骨远端粉碎性骨折的方法及疗效。方法回顾分析2011年1月-2012年9月采用切开复位锁骨远端双钢板内固定术治疗的16例锁骨远端粉碎性骨折患者临床资料。其中男9例,女7例;年龄36~71岁,平均53.6岁。致伤原因:交通事故伤8例,运动伤5例,高处坠落伤3例;均为闭合骨折。其中CraigⅡ类Ⅱ型骨折10例,CraigⅡ类Ⅴ型骨折5例,CraigⅡ类Ⅱ型合并Ⅲ类骨折1例。受伤至手术时间为12~72 h,平均48 h。术后定期X线片明确骨折愈合情况,末次随访时采用美国肩肘外科医师学会(ASES)评分标准评价术后肩关节功能。结果16例均获随访,随访时间13~17个月,平均13.6个月。X线片示术后骨折均获解剖复位和骨性愈合,愈合时间为4~6个月,平均5.6个月。随访期间无钢板周围骨折、钢板断裂、畸形愈合、骨不连及创伤性关节炎等并发症发生。末次随访时ASES评分为86~93分,平均91分。结论采用双钢板内固定治疗锁骨远端粉碎性骨折,可获坚强固定,避免干扰肩锁关节和肩关节活动,是一种安全可靠的治疗方法。     

锁骨远端解剖型锁定钢板治疗锁骨远端骨折的疗效分析

目的探讨锁骨远端解剖型锁定钢板在锁骨远端骨折治疗中的应用。方法对26例CraigⅡ类Ⅱ、Ⅴ型锁骨外1/3骨折进行切开复位锁骨远端解剖型锁定钢板固定。结果本组24例获得随访6~24个月,肩关节功能评分为88～97分,平均92分,优16例,良6例,可2例,优良率为91.7%。结论采用锁骨远端解剖型锁定钢板治疗CraigⅡ类Ⅱ、Ⅴ型锁骨远端骨折,术后肩关节疼痛及肩关节活动受限发生率低,术后并发症少,有利于肢体早期功能恢复。     

CAS锁定钢板内固定治疗NeerⅡ型锁骨远端骨折

目的探讨CAS锁定钢板内固定治疗NeerⅡ型锁骨远端骨折的临床疗效。方法回顾性分析自2014-03—2016-06采用CAS锁定钢板内固定治疗的26例NeerⅡ型锁骨远端骨折。骨折复位后用克氏针临时固定,CAS锁定钢板置于锁骨远端,远端置入5~8枚直径2.4 mm锁定螺钉,近端至少置入3枚直径4 mm锁定螺钉。结果 26例均获得随访,随访时间平均13.6(10~19)个月。术后5~7周骨折临床愈合,骨折牢固愈合时间平均12(10~13)周。采用Karlsson标准评价骨折愈合质量:优19例,良7例。术后6个月采用Neer肩关节评分标准评定疗效:优15例,良9例,可2例,优良率为92.3%。末次随访时肩关节功能Constan-Murley评分76~98分,平均91.6分。结论 CAS锁定钢板内固定治疗NeerⅡ型锁骨远端骨折可取得满意疗效,患者可以早期进行功能锻炼,有利于肩关节功能恢复,且并发症较少。     

锁骨远端解剖锁定钢板联合克氏针内固定治疗Neer Ⅱb型锁骨远端骨折

目的探讨锁骨远端解剖锁定钢板联合克氏针内固定治疗NeerⅡb型锁骨远端骨折的临床疗效。方法回顾性分析自2016-01—2017-08采用锁骨远端解剖锁定钢板联合克氏针内固定治疗的29例新鲜闭合性NeerⅡb型锁骨远端骨折。末次随访时采用肩关节功能Constant-Muley评分标准评定疗效。结果本组手术时间45~65(50.0±6.5)min,出血量55~98(85.0±7.1)ml。29例均获得随访,随访时间平均8(5~12)个月。所有患者均未出现切口感染、肩部疼痛、螺钉松动及骨折不愈合等并发症。骨折愈合时间平均8.5(8~10)周。末次随访时肩关节功能Constant-Muley评分平均92.5(83~97)分,优22例,良5例,可2例,优良率93.1%。结论锁骨远端解剖锁定钢板联合克氏针内固定治疗NeerⅡb型锁骨远端骨折可以有效固定骨折端,提高骨折断端稳定性,术后患者可早期功能锻炼,有利于骨折愈合及肩关节功能恢复。     

锁骨远端锁定钢板内固定治疗锁骨近端骨折的疗效分析

目的探讨采用锁骨远端锁定钢板反向放置内固定治疗锁骨近端骨折的手术方法及临床疗效。方法回顾性分析自2012-03—2016-03采用切开复位锁骨远端锁定钢板反向放置内固定治疗的9例锁骨近端骨折。解剖复位骨折端后将锁骨远端锁定钢板反向放置,必要时只需适度调整锁定钢板的弯度即可。结果本组9例获得8~13个月随访,平均11.6个月。术后X线片可见骨折基本解剖复位,内固定位置正常,术后5~9个月骨性愈合。切口均一期愈合,未出现神经血管损伤、气胸等并发症。骨折愈合后取出内固定物。末次随访时肩关节功能Constant-Murley评分92~98分,平均95分。患侧胸锁关节无明显疼痛,肩关节功能及上肢肌力恢复良好。结论切开复位锁骨远端锁定钢板反向放置内固定治疗锁骨近端骨折疗效肯定,固定可靠,患者可早期进行功能锻炼,并发症少。     

锁定钢板联合TightRope系统内固定治疗Neer ⅡB型锁骨远端骨折

目的观察锁骨远端解剖型锁定钢板联合Tight Rope系统内固定治疗Neer ⅡB型锁骨远端骨折的临床疗效。方法回顾性分析自2012-07—2015-07采用锁骨远端解剖型锁定钢板联合Tight Rope系统内固定治疗的31例Neer ⅡB型锁骨远端骨折。结果本组均获得随访1~4年,平均2.6年。骨折愈合时间平均9.5(8~12)周。末次随访时肩关节功能Constant评分平均96.6(90~100)分,其中疼痛平均13.0(10~15)分,活动范围平均19.5(15~20)分,主动运动平均40.6(38~42)分,肌肉力量平均23.5(22~25)分。按照修正的肩关节MSRS评分评定疗效:优29例,良1例,可1例,优良率为96.8%。结论锁骨远端解剖型锁定钢板联合Tight Rope系统内固定治疗Neer ⅡB型锁骨远端骨折疗效满意,术后并发症少,肩关节功能恢复良好。     

锁定钢板治疗锁骨远端Neer Ⅱb型骨折的疗效分析

[目的]探讨锁骨远端锁定加压钢板内固定方法治疗NeerⅡb型锁骨远端骨折的临床疗效。[方法]回顾性分析2012年3月~2013年8月采用锁骨远端前外侧lateral compression plate(LCP)治疗15例NeerⅡb型锁骨远端骨折的资料,男9例,女6例;年龄22~64岁,平均42.1岁;左侧5例,右侧10例。采用锁骨上方横行切口,复位骨折后使用锁定钢板内固定,对于钢板固定后肩锁关节仍不稳定的,采用喙突置入带线锚钉修复喙锁韧带。术后定期摄X线片,采用Constant、SF-36评分系统分别对术后肩关节功能及全身功能进行评定。[结果]15例锁骨远端骨折患者均获随访,随访时间14~26个月,平均20.5个月。X线片显示锁骨骨折均在4~6个月内愈合,平均骨折愈合时间4.5个月。Constant肩关节功能评分,优11例,良4例,优良率100%。与健侧肩关节的功能评分接近。SF-36评分为85.5~100分,平均94.6分。末次随访时,无1例发生钢板断裂、钢板周围骨折和肩袖损伤等并发症。[结论]切开复位锁骨远端锁定加压钢板内固定方法治疗NeerⅡb型锁骨远端骨折能取得良好的临床疗效,具有肩关节功能恢复好、并发症少等优点,是治疗锁骨远端骨折较好的内固定方法。     

锁定加压钢板治疗锁骨远端Neer IIB 型骨折

 目的 探讨采用锁骨远端前外侧锁定加压钢板(locking compression plate, LCP)治疗锁骨远端Neer IIB 型骨折的疗效。方法 回顾性分析2009 年1 月至2010 年10 月采用锁骨远端前外侧LCP治疗11 例Neer IIB 型锁骨远端骨折的资料, 男9 例, 女2 例;年龄23~43 岁, 平均37.2 岁;左侧5例, 右侧6例;损伤至手术时间为24~72 h, 平均48 h。骨折复位后将LCP 置于锁骨远端上方, 首先采用锁定螺钉固定锁骨远端, 可根据骨折的长度选择3~6枚2.5 mm 的锁定螺钉, 然后用3.5 mm锁定螺钉固定骨折近端, 无需修复喙锁韧带。采用美国肩肘外科医师学会(American Shoulder and Elbow Surgeons, ASES)评分评价术后肩关节功能。结果 11 例患者均获得随访, 随访时间为9~12 个月, 平均10.3 个月。X 线片示锁骨骨折均愈合, 其中10 例在术后6 个月内骨折愈合, 1 例在术后9 个月骨折愈合。11 例患者ASES 评分为84~91 分, 平均89.1 分, 与健侧肩关节的功能评分相近。末次随访时, 无一例发生钢板断裂、钢板周围骨折和肩袖损伤等并发症。结论 采用锁骨远端前外侧LCP治疗Neer IIB 型锁骨远端骨 折可以稳定锁骨远端, 避免骨折不愈合和经肩关节固定锁骨远端的并发症。     

两种内固定治疗锁骨远端粉碎性骨折的疗效比较

目的比较两种内固定治疗锁骨远端粉碎性骨折的临床疗效。方法将48例锁骨远端粉碎性骨折患者按内固定方式不同分为锁骨钩钢板组(22例)和微型双钢板组(26例)。比较两组手术时间、术中出血量、住院费用、骨折愈合时间、肩关节运动范围及术后并发症发生情况。采用Constant-Murley评分评价肩关节功能。结果 48例患者均获得随访,时间12～17个月。手术时间和术中出血量两组比较差异均无统计学意义(P 0. 05)。住院费用和骨折愈合时间微型双钢板组少于锁骨钩钢板组(P 0. 001)。Constant-Murley评分:术后2个月微型双钢板组优于锁骨钩钢板组(P 0. 001);术后6个月、内固定取出前1周及末次随访时两组比较差异均无统计学意义(P 0. 05)。术后并发症发生率锁骨钩钢板组高于微型双钢板组(P 0. 05)。结论两种内固定治疗锁骨远端粉碎性骨折均可获得较好的临床效果,但微型双钢板垂直内固定住院费用较少,骨折愈合时间更短,术后并发症少,更具优势。     

解剖锁定钢板联合锚钉治疗NeerⅡb型锁骨远端粉碎骨折

目的探讨解剖锁定钢板联合锚钉治疗NeerⅡb型锁骨远端粉碎骨折的疗效。方法采用解剖锁定钢板联合锚钉治疗18例NeerⅡb型锁骨远端粉碎骨折患者。末次随访采用Constant-Murley评分标准进行肩关节功能评定。结果患者均获得随访,时间10~27个月。1例术后发生浅表切口感染,经换药及口服抗生素后愈合;其余17例均无切口感染、骨折延迟愈合、内固定松动、断裂及继发骨折等并发症发生。骨折全部愈合,时间10~20周。末次随访时,喙锁间距患侧与健侧比较差异无统计学意义(P>0.05);Constant-Murley评分为81~98分,其中优14例,良4例。结论解剖锁定钢板联合锚钉治疗NeerⅡb型锁骨远端粉碎骨折,可获得接近解剖的喙锁间距及良好的肩关节功能,且骨折愈合快、并发症少。     

关节镜下双Endobutton钢板结合经皮克氏针髓内固定治疗NeerII型锁骨远端骨折疗效分析

目的 探讨关节镜下双Endobutton钢板结合经皮克氏针髓内固定治疗NeerII型锁骨远端骨折的临床疗效。 方法 回顾性分析我院骨科2020年9月至2022年1月间13例NeerII型锁骨远端骨折经关节镜下双Endobutton钢板结合经皮克氏针髓内固定手术的临床结果。通过收集术前及末次随访时患者的Constant评分,VAS疼痛评分,肩关节前屈、外展活动度评价患者术后肩关节功能恢复情况,通过术后X片随访了解骨折愈合的时间。 结果 本组患者共13例,男性8例,女性5例,平均年龄37.6岁（21-53岁）,按照Neer分型,11例为NeerIIA型,2例是NeerIIB型。13例患者均获得随访,平均随访时间6.5月（4-9月）。术前患者的Constant评分、VAS疼痛评分、肩关节前屈活动度、外展活动度分别是40.30±5.75分、4.69±1.25分、70.77±6.41度、64.23±7.60度。术后末次随访Constant评分、VAS疼痛评分、肩关节前屈活动度、外展活动度分别是 96.00±5.96分、0.23±0.60分、169.23±11.52度、163.77±12.40度,较术前均有明显改善,差异有统计学意义（P=0.000）。所有患者骨折均愈合,平均愈合时间4.6月（3-8月）。 结论 关节镜下双Endobutton钢板结合经皮克氏针髓内固定治疗NeerII型锁骨远端骨折疗效满意,同时具有微创、不干扰肩峰下间隙、不需要二次手术取出内固定等优点,可以作为治疗NeerII锁骨远端骨折的手术选择方案。     

Clavicle fractures in head-injured children

Between the years 1960 and 1985, 499 children were treated at Rancho Los Amigos Hospital for residuals of head trauma. Of these, 35 had fractures of the clavicle (38 total fractures). Two of the patients had lateral physeal injuries and subsequently developed a "double" clavicle. All of the clavicle fractures healed without immobilization and exhibited excellent remodeling. All patients recovered complete range of motion of the shoulder. Only one of the patients required surgery (for removal of a tender bony prominence after the formation of a "double" clavicle).     

Treatment of distal clavicle fracture with distal radius volar locking compression plate

Objective: To observe the early clinical outcomes of the internal fixation with distal radius volar locking compression plate (LCP) in treatment of distal clavicle fracture.Methods: Six patients with unilateral distal clavicle fractures, identified as type Ⅱ according to Neer classification system, including 4 males and 2 females, were treated with open reduction and internal fixation using a distal radius volar LCP. Bone union was evaluated by routine X-ray radiography, and shoulder joint function were assessed by Constant score system.Results: All fractures achieved bone union at 6 to 8 weeks postoperatively, and Constant scores ranged from 95 to 100 at the postoperative 10 to 12 weeks.Conclusion: Fixation of distal clavicle fracture with distal radius volar LCP demonstrates excellent effects of bone union with rarely early complications, thus providing a new technique to treat distal clavicle fracture.     

锁骨钩钢板内固定术后肩部疼痛和外展受限的分析

目的探讨采用锁骨钩钢板内固定治疗锁骨远端骨折和肩锁关节脱位术后并发肩部疼痛和肩关节外展受限的原因。方法将60例锁骨远端骨折和肩锁关节脱位患者随机分为A、B两组。锁骨钩钢板外侧钩的安置采用两种不同方式：A组（30例）患者术中仅显露锁骨骨折断端及肩锁关节,不显露肩峰,锁骨钩钢板外侧钩于肩锁关节后方盲插入肩峰下进行固定;B组（30例）患者同时显露肩峰,将锁骨钩钢板外侧钩紧贴肩峰于骨膜下插入进行固定,以减少钢板钩部与肩峰之间软组织嵌入。对两组术后出现患侧肩关节疼痛不适及外展受限发生率进行组间对比分析。结果 55例患者获得12-24个月随访,5例失访。肩关节疼痛及外展轻度受限B组28例中出现3例,发生率为10.7%;A组27例中出现9例,发生率为33.3%,两组比较差异有统计学意义（P〈0.05）。结论术中充分显露肩峰,紧贴肩峰插入锁骨钩钢板外侧钩,使外侧钩部与肩峰紧密贴合,可减少其间软组织嵌入和肩峰与钢板钩部撞击,从而减少术后肩关节疼痛及外展受限等并发症的发生率。     

Management of acute unstable distal clavicle fracture with a modified coracoclavicular stabilization technique using a bidirectional coracoclavicular loop system

Background

Fracture of the distal clavicle is not uncommon. Despite the vast literature available for the management of this fracture, there is no consensus regarding the gold standard treatment for this fracture.

Purpose

To assess the clinical and radiographic outcomes and complications of acute unstable distal clavicle fracture when treated by a modified coracoclavicular stabilization technique using a bidirectional coracoclavicular loop system.

Methods

Thirty-nine patients (32 males, 7 females) with acute unstable distal clavicle fractures treated by modified coracoclavicular stabilization using the surgical technique of bidirectional coracoclavicular (CC) loops seated behind the coracoacromial (CA) ligament were retrospectively reviewed. Mean follow-up time was 35.7 months (range 24–47 months). The outcomes measured included union rate, union time, CC distances when compared to the patients’ uninjured shoulders, and the Constant and ASES shoulder scores, which were evaluated 6 months after surgery.

Results

All fractures displayed clinical union within 13 weeks postoperatively. The mean union time was 9.2 weeks (range 7–13 weeks). At the time of union, the CC distances on the affected shoulders were on average 0.9 mm (range 0–1.6 mm) longer than the unaffected shoulders. At 6 months after surgery, the Constant and ASES scores were on average 93.4 (72–100) and 91.5 (75–100), respectively. No complications related to the fixation loops, musculocutaneous nerve injuries, or fractures of coracoid or clavicle were recorded. One case of surgical wound dehiscence was observed due to superficial infection. Enlargement of the clavicle drill hole without migration of the buttons was observed in 9 out of 16 cases at a follow-up time of at least 30 months after the original operation.

Conclusions

Modified CC stabilization using bidirectional CC loops seated behind the CA ligament is a simple surgical technique that naturally restores stability to the distal clavicle fracture. It also produces predictable outcomes, a high union rate, good to excellent shoulder function, and a low complication rate. The buttons and suture loops were routinely removed in a second operation in order to prevent late stress fracture of the clavicle.

     

Use of the AO hook-plate for treatment of unstable fractures of the distal clavicle

Introduction We used a new internal fixative implant, the AO clavicle hook-plate, for treatment of unstable fractures of the distal clavicle. This study describes the operative procedure and the clinical results obtained, as well as discussion of the advantages and problems encountered. Patients and methods Fifteen consecutive patients with unstable fractures of the distal clavicle (Neer type II) were treated using AO clavicle hook-plates. The average age of patients was 47 years and there were 13 males and 2 females. The mean follow-up period was 15.5 months. Plain radiographs of clavicles were used to assess bony union. Functional recovery of the shoulder joint was assessed using the Constant–Murley scoring system. Results All fractures eventually achieved solid bony union within 4 months after surgery. Thirteen patients (87%) showed hook migration into the acromion. Clinical results were excellent with a mean Constant–Murley score of 89 points at final follow-up. Conclusion AO clavicle hook-plates are useful fixative implants for unstable fractures of the distal clavicle. Static fixation was achieved and physiotherapy can be started immediately after surgery. Early removal of the implant is recommended however because hooks inserted under the acromion migrated into the bone in most cases.     

Treatment of unstable distal clavicle fractures using two suture anchors and suture tension bands

Objective

The study presents a surgical technique using two suture anchors combined with two non-absorbable suture tension bands and the clinical and radiological results obtained in patients with acute distal clavicle fractures associated with coracoclavicular ligaments disruption.

Materials and methods

Nineteen patients with distal clavicle fractures were included with a mean follow-up of 25 months. All patients had type IIb fractures according to the Neer classification. Coracoclavicular ligaments were reconstructed using two suture anchors to maintain distal clavicle in an anatomical position, and supplementary interfragmentary fixation was performed using two non-absorbable suture tension bands in figure-of-eight configurations. Functional outcomes were assessed at final follow-up visits using the Constant score.

Results

The numbers of lateral fragments averaged 1.4. Seventeen patients maintained the same vertical coracoclavicular distance between both shoulders. However, in two patients, the coracoclavicular distance of the injured shoulder increased by 50% compared with that of the contralateral shoulder. Fracture union was obtained in 18 patients at a mean 4.8 months postoperatively. One patient had symptomatic nonunion until 9 months postoperatively, and subsequently, distal clavicle resection was performed. Two patients showed delayed union and achieved fracture union at 9 and 10 months postoperatively, respectively. Clavicular erosion was found in two patients. The lateral fragment of one patient united in an upward angulated position caused by over-tightening of the medial clavicle. The average Constant score improved to 94.

Conclusion

Coracoclavicular reconstruction using two suture anchors and supplementary interfragmentary fixation using two non-absorbable suture tension bands for acute distal clavicle fracture are reliable techniques for restoring stability in patients with acute distal clavicle fracture.     

Surgical treatment for distal clavicle fracture associated with coracoclavicular ligament rupture using a cannulated screw fixation technique

BACKGROUND: A clavicle fracture is a common traumatic injury. However, the high percentage of distal clavicle fractures associated with a rupture of the coracoclavicular (CC) ligament can result in delayed union or nonunion. There is no standard treatment for a clavicle fracture. This report introduces a method for treating distal clavicle fractures associated with a ruptured CC ligament using a cannulated screw. METHODS: Seventeen patients suffering from a clavicle fracture caused by a rupture of the CC ligament were treated with a closed reduction and a cannulated screw fixation technique. Twelve patients were male and five were female and the average age was 30.5 years (range, 8-64 years). The patients were assessed using a clinical and radiologic evaluation as well as by the University of California at Los Angeles (UCLA) shoulder rating scale for 12 to 16 months after surgery. RESULTS: After confirming the formation of a callus, the implants were routinely removed approximately 8 weeks after surgery in all patients except for one. In this patient, the implant was removed 16 weeks after surgery as a result of a loosened screw, which caused displacement at the fracture site. During the final follow-up, the fracture site displayed nonunion and a partially limited range of motion (ROM). The shoulder function of the other 16 patients was restored to the preinjury level after 4 approximately 6 months of treatment. In one patient, heterotopic ossification was observed along the CC ligament without any functional deficit. All but one patient showed good results according to the UCLA scale. CONCLUSIONS: The cannulated screw fixation technique can maintain the rigid fixation of fracture fragments and allow an early return to work and sport activities. Therefore, the cannulated screw fixation technique is expected to be a useful method for treating distal clavicle fractures associated with a coracoclavicular ligament rupture.