钩钢板治疗Neer II型锁骨骨折术后锁骨中段骨折的危险因素分析

目的分析钩钢板治疗Neer II型锁骨骨折术后锁骨中段骨折的潜在危险因素。 方法在2009年3月至2019年7月期间,有294例患者使用了钩钢板治疗锁骨远端骨折并符合入选标准，其中279例术后未发生锁骨中段骨折的患者（对照组）、15例发生了术后锁骨中段骨折的患者（并发症组）。本研究收集了患者的数据,包括性别、年龄、骨折患侧、体重指数、吸烟情况、最内侧螺钉的种类、是否由住院医师作为术者进行手术、术中钩钢板是否进行了塑型、钢板的孔数、钩的深度、并发症的发生时间和发生时有无第二次创伤。本研究采用卡方检验对所有潜在的危险因素在对照组和并发症组间进行了比较。最后对具有统计学差异的变量进行了Logistic回归分析。 结果高龄患者在使用钩钢板治疗锁骨远端骨折后,更容易出现锁骨中段骨折（OR= 3.478; 95% CI : 1.719~15.407; P= 0.003）。 结论患者高龄可以显著增加钩钢板固定后锁骨中段骨折的发生率。

Risk factors analysis of clavicular midshaft fractures after hook plate fixation for the treatment of Neer type II clavicular fractures

BackgroundDistal clavicular fracture is a common traumatic injury. Given the high rates of non-union after non-operative treatment, it is recommended that clavicular fractures of Neer type II are treated surgically due to their unstable nature. The clavicular hook plate is one of the recommended devices for treating distal clavicular fractures. The clavicle hook plate works according to the principle of leverage, where the distal part is designed as a hook that is placed beneath the acromion, and the proximal portion is designed as a plate. Although it is easy to manipulate the hook plate during surgery, which is associated with excellent functional outcomes for the shoulders, the high complication rate of 40.7% is problematic. The complications caused by the hook under the acromion are common and include acromial osteolysis, acromioclavicular joint arthrosis, subacromial impingement, and rotator cuff injury. Many authors have discussed these complications, and some of them are considered to be associated with highly concentrated subacromial stress. However, clavicular midshaft fractures on another stress concentration point are rarely reported or investigated due to their lower incidence. ObjectiveTo identify and analyze the potential risk factors of clavicular midshaft fractures after hook plate fixation to treat Neer type II clavicular fractures. MethodsFrom March 2009 to July 2019, 294 patients treated with hook plates for distal clavicular fractures met the inclusion criteria during the period. The study sample comprised 279 patients without clavicular midshaft fractures (control group) and 15 patients with clavicular midshaft fractures (complication group) . Data collection included gender, age, affected side, body mass index, smoking status, type of medial screw used, whether the surgery was performed by a resident, whether the hook plate was bent during the surgery, number of holes in the plate, depth of the hook, and the time and causes of this complication. The Chi-square test was used to compare all potential risk factors between the two groups. Only a statistically significant predictive variable was included in the final logistic regression. ResultsOlder patients with distal clavicular fracture treated with hook plate are more likely to develop clavicular midshaft fractures (OR= 3.478; 95% CI : 1.719-15.407; P= 0.003) . ConclusionThe risk of clavicular midshaft fracture after hook plate fixation could be significantly increased by advanced age.