Loriaut Philippe, Moreau Pierre-Emmanuel, Dallaudière Benjamin, Pélissier Alexandre, Vu Hoang Duc, Massin Philippe, Boyer Patrick
Department of Orthopaedic Surgery, Bichat Claude Bernard Hospital, Paris Diderot University, 46 Rue Henri Huchard, 75877, Paris Cedex 18, France.
Department of Radiology, Bichat Claude Bernard Hospital, Paris Diderot University, 46 Rue Henri Huchard, 75877, Paris Cedex 18, France.
Knee Surg Sports Traumatol Arthrosc. 2015 May;23(5):1429-1433. doi: 10.1007/s00167-013-2772-9. Epub 2013 Nov 12.
The purpose of this study was to assess the clinical and radiological outcomes of an arthroscopically assisted fixation of type IIB fractures using a double button device.
Twenty-one patients with a type IIB displaced fracture of the clavicle who received an arthroscopically assisted fixation using a double button device were enrolled from 2009 to 2011. Clinical assessment included the patient's demographics, cause of injury, delay before surgery, time for surgery, time before resuming work and sports, the Shoulder and Hand (QuickDASH) score, the Constant-Murley score and the visual pain analogue scale (VAS). Radiological examination consisted of anteroposterior and axillary radiographs.
The median age of patients was 33 years (range 18-67). Mean follow-up was 35 ± 8.9 months (range 24-51 months). The average delay before surgery was 3 days (range 1-7). At final follow-up, the mean QuickDASH score, Constant score and VAS were respectively 3.2 ± 6 (range 0-25), 94.8 ± 9.9 (range 62-100) and 0.5 ± 1.2 (range 0-4). Seventeen (81 %) patients were able to resume work, including heavy manual labour, and to resume their sport activities as well. Postoperative complications included one transient adhesive capsulitis, a symptomatic acromioclavicular joint osteoarthritis and an implant failure with nonunion. Bony union was achieved in all other patients.
This study has demonstrated that the arthroscopic treatment using a double button device was effective at providing a satisfactory functional outcome, minimizing the risk of complications and presenting low implant failure and low nonunion rates in patients with Neer type IIB fractures of the distal clavicle. Such results lead us to consider this minimally invasive technique as a first-choice treatment.
IV.
本研究旨在评估使用双纽扣装置关节镜辅助固定IIB型骨折的临床和放射学结果。
2009年至2011年纳入21例接受双纽扣装置关节镜辅助固定的锁骨IIB型移位骨折患者。临床评估包括患者的人口统计学资料、受伤原因、手术前延迟时间、手术时间、恢复工作和运动的时间、肩手（QuickDASH）评分、Constant-Murley评分和视觉疼痛模拟量表（VAS）。放射学检查包括前后位和腋位X线片。
患者的中位年龄为33岁（范围18 - 67岁）。平均随访时间为35±8.9个月（范围24 - 51个月）。手术前平均延迟时间为3天（范围1 - 7天）。在末次随访时，平均QuickDASH评分、Constant评分和VAS分别为3.2±6（范围0 - 25）、94.8±9.9（范围62 - 100）和0.5±1.2（范围0 - 4）。17例（81%）患者能够恢复工作，包括重体力劳动，也能恢复运动活动。术后并发症包括1例短暂性粘连性关节囊炎、1例症状性肩锁关节骨关节炎和1例植入物失败伴骨不连。所有其他患者均实现了骨愈合。
本研究表明，使用双纽扣装置的关节镜治疗在为Neer IIB型锁骨远端骨折患者提供满意的功能结果、将并发症风险降至最低以及呈现低植入物失败率和低骨不连率方面是有效的。这些结果使我们认为这种微创技术是首选治疗方法。
IV级。
