双钢板内固定治疗锁骨近端粉碎性骨折

目的探讨采用双钢板内固定术治疗锁骨近端粉碎性骨折的方法及临床疗效。方法 2011年2月-2012年11月采用切开复位锁骨近端双钢板内固定治疗13例锁骨近端粉碎性骨折患者,其中男性5例,女性8例;年龄42-72岁,平均57.7岁。致伤原因：道路交通伤6例,运动伤4例,坠落伤3例。均为闭合性骨折,受伤至手术时间为12-72h,平均为48h。术前行锁骨正轴位X线片以及CT三维重建扫描检查,以了解骨折的损伤类型、受累范围以及有无合并同侧肩胛骨损伤。根据Craig分型：Ⅱ型5例、Ⅲ型3例、Ⅳ型3例、Ⅴ型2例。术后定期摄X线片观察骨折愈合情况。采用美国肩肘外科医师学会（American Shoulder and Elbow Surgeons,ASES）标准评价术后肩关节功能,同时记录相关并发症发生情况。结果 13例均获得随访,随访时间为7-18个月,平均12.3个月。X线片示术后5-6个月骨折端愈合,平均5.2个月。末次随访时未见内固定失败、骨不连、钢板周围骨折、创伤性关节炎等并发症发生。末次随访时ASES评分为87-92分,平均90.2分,与健侧肩关节的功能评分接近。结论采用双钢板内固定术治疗锁骨近端粉碎性骨折可以在直视下实现解剖复位,可获得坚强稳定的固定效果,是一种安全可靠的治疗方法。

Dual plate fixation for proximal comminuted clavicle fractures

Objective To evaluate the technique and effectiveness of dual plate fixation for proximal comminuted clavicle fractures. Methods Between Feb. 2011 and Nov. 2012,13 patients with proximal comminuted clavicle fractures were treated using dual plating fixation, including 5 males and 8 females with the mean age of 57.7 years（ range,42-72 years）. All the patients had closed injury,which was caused by traffic accident in 6 cases,sport injury in 4 cases, and falling in 3 cases. The average interval from injury to surgery was 48 hours （range, 12-72 hours）. Routine X-ray and CT scan were taken for confirmation of classification and involvement and ipsilateral shoulder blade injury. According to Craig classification system, 5 cases were rated as type Ⅱ , 3 as type Ⅲ, 3 as type Ⅳ, and 2 as type V. The X-ray films were taken during the follow-up. The functional recovery of the shoulder joint was assessed using the American Shoulder and Elbow Surgeons （ASES） rating score system. The complications were also recorded. Results All the patients were followed up for 7 to 18 months （ mean, 12. 3 months ）. All the fractures got solid bony union eventually. The radiographic examination demonstrated that the mean time of bone healing was 5.2 months （ range ,5-6 months ）. Complications such as implant failure, nonunion, implant related fracture, or post-traumatic arthritis were not observed during the follow-up. The mean ASES score was 90. 2 （ range, 87- 92） on the injured side, which was close to the eontralateral side. Conclusion Dual plate fixation for proximal eomminuted clavicle fractures can achieve anatomic reduction and obtain a rigid stabilization, which is a safe and effective method.