Hollo David, Kolling Christoph, Audigé Laurent, Moro Fabrizio, Rikli Daniel, Müller Andreas M
Department of Orthopedic Surgery and Traumatology, University Hospital Basel, Basel, Switzerland.
Department of Shoulder and Elbow Surgery, Schulthess Klinik, Zürich, Switzerland.
JSES Int. 2020 Jun 1;4(3):508-514. doi: 10.1016/j.jseint.2020.04.002. eCollection 2020 Sep.
The goal of this study was to evaluate whether plating and cortical bone grafting of shortened clavicular nonunions would restore clavicular length and enable bone healing. The association between the clavicular length difference (CLD) between sides and long-term functional outcome was also explored.
For this retrospective 2-center study, patients who underwent plate fixation with cortical bone grafting of a clavicular nonunion were assessed after ≥2 years. The CLD and bone union were assessed using radiography and navigation ultrasound. The functional outcome was determined by the Constant score, Simple Shoulder Test score, and Subjective Shoulder Value, as well as local pain (0-10 numeric rating scale).
Between 2 and 13 years after surgery, 25 patients (mean age, 53 years; 13 female patients) were examined. The median CLD was 0 mm (range, -17 to 13 mm) on ultrasound measurements and 2 mm (range, -32 to 9 mm) on radiographs. At follow-up, the median Constant score, Simple Shoulder Test score, Subjective Shoulder Value, and pain level were 82 points (range, 38-95 points), 12 points (range, 3-12 points), 95% (range, 60%-100%), and 0 (range, 0-8), respectively. There was no correlation between the CLD and all functional outcome scores. Bone union was achieved in all patients. After plate removal, 4 refractures occurred, 3 of which required revision.
Plate fixation with cortical bone grafting of clavicular nonunions is associated with restoration of clavicular length and a high rate of bone union. There is, however, a considerable risk of refracture following plate removal. There was no association between the CLD and clinical outcome.
本研究的目的是评估对缩短的锁骨骨不连进行钢板固定和皮质骨移植是否能恢复锁骨长度并促进骨愈合。同时还探讨了两侧锁骨长度差异（CLD）与长期功能结局之间的关联。
在这项回顾性的双中心研究中，对接受锁骨骨不连钢板固定及皮质骨移植的患者进行了至少2年的随访评估。通过X线摄影和导航超声评估CLD和骨愈合情况。功能结局由Constant评分、简单肩关节测试评分、主观肩关节评价值以及局部疼痛（0 - 10数字评分量表）来确定。
术后2至13年，对25例患者（平均年龄53岁；13例女性患者）进行了检查。超声测量的CLD中位数为0毫米（范围为 - 17至13毫米），X线片测量的为2毫米（范围为 - 32至9毫米）。随访时，Constant评分、简单肩关节测试评分、主观肩关节评价值和疼痛水平的中位数分别为82分（范围为38 - 95分）、12分（范围为3 - 12分）、95%（范围为60% - 100%）和0（范围为0 - 8）。CLD与所有功能结局评分之间均无相关性。所有患者均实现了骨愈合。取出钢板后，发生了4例骨折，其中3例需要再次手术。
锁骨骨不连的钢板固定联合皮质骨移植与锁骨长度的恢复及高骨愈合率相关。然而，取出钢板后存在相当大的再骨折风险。CLD与临床结局之间无关联。
