Oki Satoshi, Matsumura Noboru, Kiriyama Yoshimori, Iwamoto Takuji, Sato Kazuki, Nagura Takeo
*Department of Orthopedics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan; †Department of Orthopedics, Nasu Red Cross Hospital, Otawara, Tochigi, Japan; ‡Department of Mechanical Systems Engineering, Faculty of Engineering, Kogakuin University, Shinjuku-ku, Tokyo, Japan; and §Department of Biomechanics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
J Orthop Trauma. 2017 Nov;31(11):e385-e389. doi: 10.1097/BOT.0000000000000931.
The purpose of this study was to describe the 3-dimensional deformities of midshaft clavicle fractures, which had been treated nonoperatively, using computed tomography (CT) surface matching.
Twenty-one patients with unilateral midshaft clavicle fracture, who had been treated nonoperatively, were enrolled and evaluated retrospectively. The 3-dimensional deformity of the fractured clavicle was evaluated by CT surface matching. CT scans of 21 age- and sex-matched patients with initial traumatic shoulder dislocation or proximal humeral fracture were enrolled as a control group, and the differences in 3-dimensional deformities and lengths of the clavicles between the fracture group and the control group were evaluated. A correlation analysis was also performed between rotational deformities and clavicular length shortening.
The affected clavicle showed 1.3 ± 6.9 degrees of downward angular deformity, 2.1 ± 8.0 degrees of anterior angular deformity, and 5.0 ± 4.9 degrees of anterior rotational deformity. Compared with the control group, the fractured clavicle showed larger anterior rotational deformity (P = 0.021). Shortening of the clavicle demonstrated negative correlation with anterior axial rotation (R = -0.534, P = 0.013), but no correlation was found between clavicular shortening and the other 2 rotational deformities.
In cases of midshaft clavicle fracture, the distal fragment usually rotates anteriorly because of its anatomical relationships. Shortening deformity after clavicle fracture was reported to change shoulder kinematics, and anterior rotational deformity might adversely affect scapular motion.
本研究的目的是利用计算机断层扫描（CT）表面匹配技术描述非手术治疗的锁骨中段骨折的三维畸形情况。
回顾性纳入并评估21例接受非手术治疗的单侧锁骨中段骨折患者。通过CT表面匹配评估骨折锁骨的三维畸形情况。纳入21例年龄和性别匹配的初次创伤性肩关节脱位或肱骨近端骨折患者的CT扫描结果作为对照组，评估骨折组与对照组之间锁骨三维畸形和长度的差异。还对旋转畸形与锁骨长度缩短之间进行了相关性分析。
患侧锁骨显示向下成角畸形1.3±6.9度，向前成角畸形2.1±8.0度，向前旋转畸形5.0±4.9度。与对照组相比，骨折锁骨显示出更大的向前旋转畸形（P = 0.021）。锁骨缩短与前轴向旋转呈负相关（R = -0.534，P = 0.013），但未发现锁骨缩短与其他两种旋转畸形之间存在相关性。
在锁骨中段骨折的病例中，由于其解剖关系，远侧骨折块通常向前旋转。据报道，锁骨骨折后的缩短畸形会改变肩部运动学，而向前旋转畸形可能会对肩胛骨运动产生不利影响。
