用多根斯氏针治疗不稳定型锁骨远端骨折——对奈氏方法的一种改良：56例连续病例系列

Treatment of Unstable Distal Clavicle Fractures With Multiple Steinmann Pins-A Modification of Neer's Method: A Series of 56 Consecutive Cases.

作者信息

Kwak Sang H, Lee Young H, Kim Dong W, Kim Min B, Choi Ho S, Baek Goo H

机构信息

*Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea; and†Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.

出版信息

J Orthop Trauma. 2017 Sep;31(9):472-478. doi: 10.1097/BOT.0000000000000850.

DOI:10.1097/BOT.0000000000000850

PMID:28876271

Abstract

OBJECTIVES

To introduce an alternative fixation technique for Neer type II fractures using Steinmann pins (S-pins).

DESIGN

Retrospective case series study.

SETTING

Operating room followed by clinic in tertiary hospital.

PATIENTS/PARTICIPANTS: Between 2001 and 2013, among 66 consecutive patients diagnosed with Neer type II distal clavicle fractures, 11 patients were excluded and 56 clavicles of 55 patients who underwent surgical treatment with multiple transacromial S-pins were selected for analysis.

INTERVENTION

Multiple transacromial S-pin (2.0-mm diameter) fixation was performed. Interfragmentary fixation was performed with 2.7-mm screws in case of oblique fractures.

MAIN OUTCOME MEASURES

Radiographic results, complications, and clinical outcomes including the Constant-Murley score, the University of California at Los Angeles Shoulder score, and the disabilities of the arm, shoulder, and hand score were evaluated.

RESULTS

Radiologic union was achieved in all patients. Coracoclavicular distance was increased by 6.4% compared with that of the uninjured side (P < 0.001). Fourteen patients had lateral migrations of 1 pin (mean migration distance, 11.6 mm). The mean Constant-Murley score was 94.3 (range, 85-100), mean University of California at Los Angeles score was 33.1 (range, 29-35), and mean disabilities of the arm, shoulder, and hand score was 2.7 (range, 0-8.3). The average follow-up period was 30.5 months (range, 24-81 months).

CONCLUSIONS

Good functional and radiologic results were achieved by the insertion of multiple transacromial S-pins with interfragmentary screw fixation. With its wide indication and relatively simple procedure, this technique may be a possible surgical option for the treatment of Neer type II distal clavicle fractures.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

介绍一种使用斯氏针（S 针）治疗 Neer II 型骨折的替代固定技术。

设计

回顾性病例系列研究。

地点

三级医院的手术室及门诊。

患者/参与者：2001 年至 2013 年期间，在 66 例连续诊断为 Neer II 型锁骨远端骨折的患者中，排除 11 例，选取 55 例接受多根经肩峰 S 针手术治疗的患者的 56 根锁骨进行分析。

干预措施

采用多根经肩峰 S 针（直径 2.0 毫米）固定。对于斜形骨折，采用 2.7 毫米螺钉进行骨折块间固定。

主要观察指标

评估影像学结果、并发症及临床疗效，包括 Constant-Murley 评分、加州大学洛杉矶分校肩关节评分以及上肢、肩部和手部功能障碍评分。

结果

所有患者均实现影像学愈合。与健侧相比，喙锁间距增加了 6.4%（P < 0.001）。14 例患者有 1 根针出现外侧移位（平均移位距离为 11.6 毫米）。Constant-Murley 评分平均为 94.3（范围 85 - 100），加州大学洛杉矶分校评分平均为 33.1（范围 29 - 35），上肢、肩部和手部功能障碍评分平均为 2.7（范围 0 - 8.3）。平均随访时间为 30.5 个月（范围 24 - 81 个月）。