不进行喙锁韧带增强的钢板固定术治疗不稳定型锁骨远端骨折
Use of plate fixation without coracoclavicular ligament augmentation for unstable distal clavicle fractures.
作者信息
Shin Sang-Jin, Ko Young-Won, Lee Juyeob, Park Min-Gyue
机构信息
Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
出版信息
J Shoulder Elbow Surg. 2016 Jun;25(6):942-8. doi: 10.1016/j.jse.2015.10.016. Epub 2015 Dec 23.
BACKGROUND
The purpose of this study was to evaluate the clinical and radiologic outcomes of unstable distal clavicle fractures treated with anatomic plate fixation without coracoclavicular ligament augmentation and to compare the outcome of Neer type IIA with that of type IIB.
METHODS
Twenty-five patients with unstable distal clavicle fractures who underwent anatomic plate fixation without coracoclavicular ligament augmentation were enrolled prospectively, including 9 patients of Neer type IIA and 16 patients of Neer type IIB. Clinical outcomes were evaluated using Constant and University of California-Los Angeles (UCLA) scores. Coracoclavicular distance was measured on plain radiographs.
RESULTS
Bone union was achieved in all patients. Satisfactory clinical and radiologic outcomes were obtained regardless of fracture type. After operation, the mean coracoclavicular distance on the injured side was increased by 10% compared with the uninjured side. However, between the patients who showed an increased coracoclavicular distance >10% (Constant score, 89.4 ± 3.7; UCLA score, 32.6 ± 3) and the patients with increased coracoclavicular distance <10% of the uninjured side (Constant score, 88.7 ± 3.6; UCLA score, 31.9 ± 3), there was no statistically significant difference in clinical outcomes of Constant score (P = .934) and UCLA score (P = .598).
CONCLUSION
In unstable distal clavicle fractures, precontoured anatomic plate fixation without coracoclavicular ligament augmentation showed satisfactory clinical outcomes and high union rates even with a small lateral fragment. Patients who had increased coracoclavicular distance also demonstrated satisfactory shoulder functional outcomes regardless of the fracture type. Therefore, anatomic plate fixation without additional coracoclavicular ligament augmentation can be considered one of the treatment options for unstable distal clavicle fracture.
LEVEL OF EVIDENCE
Level IV; Case Series; Treatment Study.
背景
本研究的目的是评估采用解剖钢板固定且不增强喙锁韧带治疗不稳定型锁骨远端骨折的临床和影像学结果，并比较Neer IIA型与IIB型的治疗结果。
方法
前瞻性纳入25例接受解剖钢板固定且不增强喙锁韧带的不稳定型锁骨远端骨折患者，其中Neer IIA型9例，Neer IIB型16例。采用Constant评分和加利福尼亚大学洛杉矶分校（UCLA）评分评估临床结果。在X线平片上测量喙锁距离。
结果
所有患者均实现骨愈合。无论骨折类型如何，均获得了满意的临床和影像学结果。术后，患侧平均喙锁距离较健侧增加了10%。然而，喙锁距离增加>10%的患者（Constant评分，89.4±3.7；UCLA评分，32.6±3）与喙锁距离增加<健侧10%的患者（Constant评分，88.7±3.6；UCLA评分，31.9±3）之间，Constant评分（P = 0.934）和UCLA评分（P = 0.598）的临床结果无统计学显著差异。
结论
在不稳定型锁骨远端骨折中，采用预塑形解剖钢板固定且不增强喙锁韧带，即使存在较小的外侧骨折块，也显示出满意的临床结果和高愈合率。无论骨折类型如何，喙锁距离增加的患者也表现出满意的肩部功能结果。因此，不额外增强喙锁韧带的解剖钢板固定可被视为不稳定型锁骨远端骨折的治疗选择之一。
证据级别
IV级；病例系列；治疗研究。
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