双纽扣钢板缝线与锁骨钩钢板治疗NeerⅡB型锁骨远端骨折的比较Double buttons combined with suture versus hook plate for Neer type ⅡB distal clavicle fractures
向阳;雷建平;李远辉;林志荣;
摘要(Abstract):
[目的]比较双纽扣钢板结合骨缝线固定与锁骨钩钢板治疗成人NeerⅡB型锁骨远端骨折的疗效。[方法]回顾分析2009年1月~2015年10月本科手术治疗的66例NeerⅡB型锁骨远端骨折患者。其中,32例采用双纽扣钢板结合1号Ethibond不可吸收性缝线固定(双纽扣钢板组),其余34例采用锁骨钩钢板内固定治疗(钩钢板组)。比较两组的手术时间、骨折愈合时间、重返工作岗位时间、患者满意度等,术后3、6个月,1、2年,末次随访时的Constant评分及并发症。[结果]所有患者均顺利接受手术,无血管神经损伤等并发症,两组手术时间的差异无统计学意义。纽扣钢板组与钩钢板组患者分别获(29.10±5.59)个月和(30.47±7.05)个月随访。两组患者骨折愈合时间差异无统计学意义(P>0.05)。双纽扣钢板组重返工作岗位时间明显早于钩钢板组,差异有统计学意义[(2.76±1.20)个月vs(3.37±1.44)个月,P<0.05]。末次随访时,双纽扣钢板组的满意度明显高于钩钢板组,差异有统计学意义[93.75%(30/32)vs 70.59%(24/34),P<0.05],而双纽扣钢板组并发症率显著低于钩板组[9.38%(3/32)vs 32.35%(11/34),P<0.05]。术后3个月、6个月、1年,纽扣钢板组Constant评分均优于钩钢板组,差异均有统计学意义(P<0.05)。[结论]与锁骨钩钢板相比,双纽扣钢板结合骨缝线固定治疗成人NeerⅡB型锁骨远端骨折具有术后早期功能恢复、重返工作时间短、并发症发生率低及满意度高的优势。
关键词(KeyWords): 锁骨远端骨折;骨折内固定术;双纽扣钢板;钩钢板
基金项目(Foundation):
作者(Author): 向阳;雷建平;李远辉;林志荣;
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DOI:
参考文献(References):
- [1]Oh JH,Kim SH,Lee JH,et al.Treatment of distal clavicle fracture:a systematic review of treatment modalities in 425 fractures[J].Arch Orthop Trauma Surg,2011,131(4):525-533.
- [2]Robinson CM,Cairns DA.Primary nonoperative treatment of displaced lateral fractures of the clavicle[J].Journal of Bone and Joint Surgery-American Volume,2004,86-A(4):778-782.
- [3]van der Meijden OA,Gaskill TR,Millett PJ.Treatment of clavicle fractures:current concepts review[J].J Shoulder Elbow Surg,2012,21(3):423-429.
- [4]江涛,苏海涛,朱兴阳,等.NeerⅡ型锁骨远端骨折的治疗[J].中国矫形外科杂志,2014,22(20):1825-1830.
- [5]Tiren D,Vroemen JP.Superior clavicle plate with lateral extension for displaced lateral clavicle fractures:a prospective study[J].J Orthop Traumatol,2013,14(2):115-120.
- [6]汪鹏,董宏然.锁骨远端骨折的治疗进展[J].中国矫形外科杂志,2014,22(22):2071-2074.
- [7]Shin SJ,Ko YW,Lee J,et al.Use of plate fixation without coracoclavicular ligament augmentation for unstable distal clavicle fractures[J].J Shoulder Elbow Surg,2016,25(6):942-948.
- [8]黄俊伍,罗轶,张春林,等.解剖型钢板与锁骨钩钢板治疗锁骨远端骨折的临床疗效[J].中华创伤骨科杂志,2012,28(12):1073-1077.
- [9]Sajid S,Fawdington R,Sinha M.Locking plates for displaced fractures of the lateral end of clavicle:potential pitfalls[J].Int J Shoulder Surg,2012,6(4):126-129.
- [10]朱义勇,汪建良,许科峰,等.锁骨钩钢板治疗肩锁关节脱位和锁骨远端骨折的肩痛原因分析[J].中华创伤骨科杂志,2007,9(7):692-693.
- [11]Lin HY,Wong PK,Ho WP,et al.Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesiondynamic sonographic evaluation[J].J Orthop Surg Res,2014,9(1):6.
- [12]顾昕,程彪,孙健,等.锁骨远端骨折钩钢板术后肩痛的关节镜下观察[J].中华创伤杂志,2013,29(6):645-648.
- [13]Kanchanatawan W,Wongthongsalee P.Management of acute unstable distal clavicle fracture with a modified coracoclavicular stabilization technique using a bidirectional coracoclavicular loop system[J].Eur J Orthop Surg Traumatol,2016,26(2):139-143.
- [14]Struhl S,Wolfson TS.Closed-loop double endobutton technique for repair of unstable distal clavicle fractures[J].Orthop J Sports Med,2016,4(7):2325967116657810.
- [15]Miyazaki AN,da Silva LA,do Val Sella G,et al.Evaluation of the results from surgical treatment of fractures of the lateral extremity of the clavicle,using the double ligature technique[J].Rev Bras Ortop,2015,50(2):142-147.
- [16]Cho CH,Jung JH,Kim BS.Coracoclavicular stabilization using a suture button device for neer type IIB lateral clavicle fractures[J].J Shoulder Elbow Surg,2017;26(5):804-808.
- [17]Souza Vilela JC,de Andrade RP,Jacques Goncalves LB,et al.Fractures of the distal clavicle:comparison between two surgical treatment methods[J].Rev Bras Ortop,2015,50(2):136-141.
- [18]Schliemann B,Rosslenbroich SB,Schneider KN,et al.Surgical treatment of vertically unstable lateral clavicle fractures(Neer 2b)with locked plate fixation and coracoclavicular ligament reconstruction[J].Arch Orthop Trauma Surg,2013,133(7):935-939.
- [19]Rieser GR,Edwards K,Gould GC,et al.Distal-third clavicle fracture fixation:a biomechanical evaluation of fixation[J].J Shoulder Elbow Surg,2013,22(6):848-855.