Haefeli Mathias, Schenkel Matthias, Schumacher Ralf, Eid Karim
*Center for Orthopaedic Surgery, State Hospitals Aarau and Baden, Baden †School of Life Sciences, Institute for Medical and Analytical Technologies, University of Applied Sciences Northwestern Switzerland, Muttenz, Switzerland.
Tech Hand Up Extrem Surg. 2017 Sep;21(3):91-100. doi: 10.1097/BTH.0000000000000161.
Midshaft clavicular fractures are often treated nonoperatively with good reported clinical outcome in a majority of patients. However, malunion with shortening of the affected clavicle is not uncommon. Shortening of the clavicle has been shown to affect shoulder strength and kinematics with alteration of scapular position. Whereas the exact clinical impact of these factors is unknown, the deformity may lead to cosmetic and functional impairment as for example pain with weight-bearing on the shoulder girdle. Other reported complications of clavicular malunion include thoracic outlet syndrome, subclavicular vein thrombosis, and axillary plexus compression. Corrective osteotomy has therefore been recommended for symptomatic clavicular malunions, generally using plain x-rays for planning the necessary elongation. Particularly in malunited multifragmentary fractures it may be difficult to exactly determine the plane of osteotomy intraoperatively to restore the precise anatomic shape of the clavicle. We present a technique for corrective osteotomy using preoperative computer planning and 3-dimensional printed patient-specific intraoperative osteotomy and reduction guides based on the healthy contralateral clavicle.
锁骨中段骨折大多采用非手术治疗，据报道多数患者临床效果良好。然而，患侧锁骨畸形愈合并伴有短缩的情况并不少见。锁骨短缩已被证实会影响肩部力量和运动学，导致肩胛位置改变。虽然这些因素的确切临床影响尚不清楚，但这种畸形可能会导致美观和功能受损，例如肩带负重时疼痛。锁骨畸形愈合的其他报道并发症包括胸廓出口综合征、锁骨下静脉血栓形成和腋神经丛受压。因此，对于有症状的锁骨畸形愈合，推荐采用截骨矫正术，通常使用普通X线片来规划所需的延长。特别是在畸形愈合的多段骨折中，术中可能难以准确确定截骨平面以恢复锁骨的精确解剖形态。我们介绍一种基于健侧对侧锁骨的术前计算机规划和三维打印的患者特异性术中截骨及复位导向器进行截骨矫正的技术。
