Tan Hong-Lve, Zhao Jin-Kun, Qian Chen, Shi Yan, Zhou Qi
Department of Orthopedic Surgery, Changzhou Wujin Hospital, Jiangsu University, Changzhou, China.
Orthopedics. 2012 Aug 1;35(8):e1191-7. doi: 10.3928/01477447-20120725-18.
AO clavicular hook plate fixation provides more rigid fixation and good bony union rates for Neer type II distal clavicular fractures. However, the hook may cause rotator cuff tears and subacromial impingement, which adversely affect the clinical results. T-plate fixation is another surgical method of treatment for unstable clavicle fractures, and its clinical efficacy has been demonstrated. The purpose of this study was to compare the clinical outcomes of AO clavicular hook plate and T-plate fixation for Neer type II distal clavicular fractures. Forty-two patients with Neer type II fractures were divided into 2 groups. The hook plate group comprised 23 patients who underwent hook plate fixation, and the T-plate group comprised 19 patients who underwent distal radius volar locking T-plate fixation. Hook plates were removed 3 to 14 months postoperatively in 15 patients because of shoulder function limitations. All patients were evaluated postoperatively for shoulder pain, activities of daily living, range of motion, strength, and satisfaction according to the University of California, Los Angeles (UCLA) Shoulder rating scale. All fractures in the 2 groups achieved stable fixation and bony union. Both groups yielded similar outcomes with regard to shoulder strength and patient satisfaction (P=.207 and P=.398, respectively). Significant differences existed between the 2 groups in the mean scores of shoulder pain, activities of daily living, range of motion, and total UCLA score (P=.001, P=.011, P=.038, and P=.001, respectively). More patients (74%) in the hook plate group had mild to severe shoulder pain than in the T-plate group (16%). However, shoulder pain was relieved and function improved significantly after removal of the hook plate (P=.001).
AO锁骨钩钢板固定为Neer II型锁骨远端骨折提供了更坚固的固定和良好的骨愈合率。然而，钩可能会导致肩袖撕裂和肩峰下撞击，从而对临床结果产生不利影响。T形钢板固定是治疗不稳定锁骨骨折的另一种手术方法，其临床疗效已得到证实。本研究的目的是比较AO锁骨钩钢板和T形钢板固定治疗Neer II型锁骨远端骨折的临床疗效。42例Neer II型骨折患者分为2组。钩钢板组包括23例行钩钢板固定的患者，T形钢板组包括19例行桡骨远端掌侧锁定T形钢板固定的患者。15例患者因肩部功能受限在术后3至14个月取出钩钢板。所有患者术后均根据加利福尼亚大学洛杉矶分校（UCLA）肩关节评分量表对肩部疼痛、日常生活活动、活动范围、力量和满意度进行评估。两组所有骨折均实现了稳定固定和骨愈合。两组在肩部力量和患者满意度方面的结果相似（分别为P = 0.207和P = 0.398）。两组在肩部疼痛、日常生活活动、活动范围和UCLA总分的平均得分上存在显著差异（分别为P = 0.001、P = 0.011、P = 0.038和P = 0.001）。钩钢板组有更多患者（74%）出现轻至重度肩部疼痛，高于T形钢板组（16%）。然而，取出钩钢板后肩部疼痛得到缓解，功能显著改善（P = 0.001）。
