Parry Joshua A, Van Straaten Meegan, Luo Tianyi D, Simon Anne-Laure, Ashraf Ali, Kaufman Kenton, Larson A Noelle, Shaughnessy William J
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Pediatr Orthop. 2017 Jun;37(4):227-233. doi: 10.1097/BPO.0000000000000627.
Recent clinical studies in adults have reported a higher incidence of symptomatic malunions and functional deficits in nonoperatively treated shortened midshaft clavicular fractures. We sought to determine whether functional or subjective deficits are found in adolescents after operative versus nonoperative treatment of clavicle fractures.
Adolescents with displaced midshaft clavicle fractures, >15 mm of shortening, and a minimum of 9 months of follow-up were recruited. Exclusion criteria included concomitant upper extremity injuries or abnormalities that would affect biomechanical strength testing. Sixteen patients, equally divided between nonoperative and operative plate fixation, met inclusion criteria and consented to testing. The average age (±SD) at the time of injury was 14±2 years (range, 10 to 16 y), time from injury was 22±10 months (range, 10 to 41 mo), and shortening was 24±6 mm (range, 16 to 35 mm). Consenting subjects completed a QuickDASH Score, Constant Shoulder Score, and questions regarding satisfaction with treatment. Quantitative isometric strength, range of motion, and abduction fatigue testing was performed on the involved and uninvolved sides for comparison.
Treatment groups did not differ in age, time from injury, or fracture shortening. QuickDASH and Constant Shoulder Scores were perfect in all but 1 patient in the operative group who actively complained of persistent symptomatic hardware. This patient and one other in the operative group underwent symptomatic hardware removal. There were no cases of symptomatic malunions in the nonoperative group. All patients expressed satisfaction with their treatment. Two in each treatment group were unsatisfied with the appearance of the clavicle. With the exception of a 3% decrease in abduction strength in the operative group (P=0.03) there were no differences in range of motion, isometric strength, or abduction fatigue of the involved shoulder in either treatment group.
Shortened midshaft clavicular fractures had excellent outcomes after both operative and nonoperative treatments. No subjective or objective differences were observed between treatment groups.
Level III-therapeutic, retrospective comparative study.
近期针对成人的临床研究报告称，非手术治疗的中锁骨骨干缩短骨折出现症状性畸形愈合和功能缺陷的发生率较高。我们试图确定青少年锁骨骨折手术治疗与非手术治疗后是否存在功能或主观缺陷。
招募了中锁骨骨干移位骨折、缩短超过15毫米且至少随访9个月的青少年。排除标准包括伴有会影响生物力学强度测试的上肢损伤或异常情况。16名患者符合纳入标准并同意接受测试，他们被平均分为非手术组和手术钢板固定组。受伤时的平均年龄（±标准差）为14±2岁（范围为10至16岁），受伤时间为22±10个月（范围为10至41个月），缩短为24±6毫米（范围为16至35毫米）。同意参与的受试者完成了快速残疾评定量表（QuickDASH）评分、肩关节常量评分（Constant Shoulder Score）以及关于治疗满意度的问题。对患侧和未患侧进行了定量等长肌力、活动范围和外展疲劳测试以作比较。
治疗组在年龄、受伤时间或骨折缩短方面无差异。除手术组中有1名患者主动抱怨持续存在症状性内固定物外，其余患者的QuickDASH和肩关节常量评分均为满分。该患者及手术组中的另一名患者接受了有症状内固定物取出术。非手术组未出现症状性畸形愈合病例。所有患者均对其治疗表示满意。每个治疗组中有两名患者对锁骨外观不满意。除手术组外展力量下降3%（P = 0.03）外，两个治疗组患侧肩部的活动范围、等长肌力或外展疲劳均无差异。
中锁骨骨干缩短骨折手术治疗和非手术治疗后均取得了良好的效果。治疗组之间未观察到主观或客观差异。
III级——治疗性回顾性对比研究。
