Li Liang, Wu Hongxiao, Jiang Peichao, Han Xiaochuan, Chen Shiyuan, Yu Xuezhong
Department of Orthopaedics, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China.
Exp Ther Med. 2020 Jan;19(1):451-458. doi: 10.3892/etm.2019.8233. Epub 2019 Nov 22.
This study compared the clinical efficacy of four internal fixation methods in the treatment of distal clavicle fractures, in an effort to guide appropriate selection and application in the clinic. Eighty-four patients with distal clavicle-comminuted fractures were treated with a distal clavicle anatomic plate (group A), clavicular hook plate (group B), double-plate vertical fixation (group C), or T-shaped steel plate internal fixation (group D). The Constant-Murley scoring system was used to evaluate the shoulder joint function. The fracture healing time, VAS, and postoperative complications were compared and analyzed among the four groups. According to the Constant-Murley evaluation standard, the excellent and good rates of the four groups were 94.4, 73.1, 95 and 80% in groups A-D, respectively. The excellent and good rates of Constant-Murley evaluation standard in groups A and C were significantly better than those in groups B and D (P<0.05). VAS in the distal clavicle anatomic plate group (group A), double-plate vertical fixation group (group C), and T-shaped steel plate internal fixation group (group D) were significantly better than the clavicular hook plate group (group B) (P<0.05). The incidence of postoperative complications in the clavicular hook plate group (group B) was 15.4% and in the T-shaped steel plate internal fixation group (group D) was 15%, which were significantly higher than those of the distal clavicle anatomic plate group (group A) and double-plate vertical internal fixation group (group C) (P<0.05). The treatment of distal clavicle fractures using either one of the four internal fixation techniques can obtain better clinical results. The distal clavicle anatomic plate and double-plate vertical internal fixation techniques are associated with a decreased incidence of shoulder pain, an increase in the range of motion of the shoulder, and a reduction in complications, and thus, are preferable for the early functional recovery of limbs.
本研究比较了四种内固定方法治疗锁骨远端骨折的临床疗效，旨在为临床合理选择和应用提供指导。84例锁骨远端粉碎性骨折患者分别采用锁骨远端解剖钢板（A组）、锁骨钩钢板（B组）、双钢板垂直固定（C组）或T形钢板内固定（D组）治疗。采用Constant-Murley评分系统评估肩关节功能。比较分析四组的骨折愈合时间、视觉模拟评分（VAS）及术后并发症。根据Constant-Murley评估标准，A-D组的优良率分别为94.4%、73.1%、95%和80%。A组和C组的Constant-Murley评估标准优良率显著优于B组和D组（P<0.05）。锁骨远端解剖钢板组（A组）、双钢板垂直固定组（C组）和T形钢板内固定组（D组）的VAS显著优于锁骨钩钢板组（B组）（P<0.05）。锁骨钩钢板组（B组）术后并发症发生率为15.4%，T形钢板内固定组（D组）为15%，显著高于锁骨远端解剖钢板组（A组）和双钢板垂直内固定组（C组）（P<0.05）。四种内固定技术中的任何一种治疗锁骨远端骨折均可获得较好的临床效果。锁骨远端解剖钢板和双钢板垂直内固定技术可降低肩部疼痛发生率，增加肩关节活动范围，减少并发症，因此更有利于肢体早期功能恢复。
