Melean Patricio A, Zuniga Adrian, Marsalli Michael, Fritis Nelson A, Cook Erik R, Zilleruelo Matías, Alvarez Cristian
Shoulder Surgery Unit, Orthopedics Department, Hospital del Trabajador, Santiago, Chile.
Shoulder Surgery Unit, Orthopedics Department, Hospital del Trabajador, Santiago, Chile.
J Shoulder Elbow Surg. 2015 Apr;24(4):587-92. doi: 10.1016/j.jse.2014.11.041. Epub 2015 Jan 22.
Surgical treatment with open reduction and internal fixation (ORIF) of displaced middle-third clavicular fractures resulted in shorter complete return to work periods with earlier consolidation documented on computed tomography (CT) scans in this prospective, randomized controlled trial.
The study randomized 76 consecutive patients with displaced fractures (2B1-2B2 according to Robinson) to conservative (C, n = 42) and surgical (S, n = 34) treatment with plates and screws. Bone union was documented with CT scans at 6 and 12 weeks.
Risk factors known to increase the risk of nonunion were similar between groups. Time until discharge for complete return to work was 3.7 ± 1.1 months for C and 2.9 ± 0.8 months for S (P = .003). On the CT scan at 6 weeks, 24.1% of the patients presented advanced bone union in S vs 5.3% in C (P = .05). At 12 weeks, 81% of the patients presented advanced bone union in S vs 16.7% in C (P = .005). At final follow-up, 4 nonunions were present in the C group that required surgery; in the S group, 4 patients underwent revision surgery for plate removal. At 6 and 12 months of follow-up, Constant scores were higher for the S group.
Surgical treatment with ORIF of displaced middle-third clavicular fractures achieved good and excellent functional results, shorter time to complete return to work, earlier bone union, and fewer cases of nonunions in a working population under injury compensation.
在这项前瞻性随机对照试验中，采用切开复位内固定术（ORIF）治疗移位的中1/3锁骨骨折，手术治疗组患者完全恢复工作的时间更短，且在计算机断层扫描（CT）上显示更早出现骨愈合。
该研究将76例连续的移位骨折患者（根据罗宾逊分类为2B1 - 2B2型）随机分为保守治疗组（C组，n = 42）和手术治疗组（S组，n = 34），手术治疗采用钢板螺钉固定。在6周和12周时通过CT扫描记录骨愈合情况。
已知增加骨不连风险的危险因素在两组之间相似。C组完全恢复工作直至出院的时间为3.7±1.1个月，S组为2.9±0.8个月（P = 0.003）。在6周时的CT扫描中，S组24.1%的患者出现早期骨愈合，而C组为5.3%（P = 0.05）。在12周时，S组81%的患者出现早期骨愈合，而C组为16.7%（P = 0.005）。在最终随访时，C组有4例骨不连患者需要手术治疗；S组有4例患者因取出钢板接受翻修手术。在随访6个月和12个月时，S组的Constant评分更高。
对于接受工伤赔偿的工作人群，采用ORIF手术治疗移位的中1/3锁骨骨折可取得良好及优异的功能结果，缩短完全恢复工作的时间，更早实现骨愈合，且骨不连病例更少。
