Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
J Orthop Sci. 2021 Nov;26(6):1094-1099. doi: 10.1016/j.jos.2020.09.017. Epub 2020 Nov 8.
It is unknown whether locking or nonlocking superior plate fixation is better for managing displaced midshaft clavicle fractures. Therefore, we aimed to compare the clinical and radiographic outcomes of locking and nonlocking superior plate fixation of displaced midshaft clavicle fractures.
A total of 102 consecutive patients with displaced midshaft clavicle fractures (2B1 and 2B2 in Robinson classification) participated in this randomized controlled trial; 12 patients were excluded. Surgeries were performed using a 3.5-mm Locking Compression Plate (LCP) between 2007 and 2015. Patients were treated either with a locking plate (group L, n = 45) or a nonlocking plate (group N, n = 45). In both groups, the plates were fixed to the proximal and distal clavicle with two and/or three screws, respectively. The main outcome measures were complication rates, time to bone union, and Constant score.
Forty-two patients in group L (mean age, 45.9 years) and 41 in group N (mean age, 43.6 years) were followed. The overall complication rates in groups L and N were 7.2% (three peri-implant fractures) and 7.3% (non-union, deformed plate, and peri-implant fracture), respectively (p = .98). The average time to union significantly differed between groups (L vs. N: 13.0 ± 4.1 vs. 17.5 ± 6.3 weeks; p < .01). However, the Constant score at the final follow-up was not significantly different between groups (L vs. N: 87.0 ± 12.3 vs. 89.8 ± 9.1).
Similar complication rates and clinical results were found for locking and nonlocking superior plate fixation for displaced midshaft clavicle fractures. However, the time to bone union was shorter with the locking plate. This study suggests that both plating systems are effective for treating displaced midshaft clavicle fractures.
Therapeutic, level I.
目前尚不清楚锁定或非锁定上钢板固定治疗移位的锁骨中段骨折哪种更好。因此，我们旨在比较锁定和非锁定上钢板固定治疗移位的锁骨中段骨折的临床和影像学结果。
本随机对照试验共纳入 102 例移位的锁骨中段骨折患者（Robinson 分类 2B1 和 2B2），12 例患者被排除。手术在 2007 年至 2015 年间采用 3.5 毫米锁定加压钢板（LCP）进行。患者分别接受锁定钢板（L 组，n=45）或非锁定钢板（N 组，n=45）治疗。在两组中，钢板均通过分别使用两到三个螺钉固定到锁骨近端和远端。主要观察指标为并发症发生率、骨愈合时间和Constant 评分。
L 组 42 例（平均年龄 45.9 岁）和 N 组 41 例（平均年龄 43.6 岁）患者得到随访。L 组和 N 组的总体并发症发生率分别为 7.2%（3 例植入物周围骨折）和 7.3%（骨不连、钢板变形和植入物周围骨折）（p=0.98）。两组的愈合时间平均差异有统计学意义（L 组与 N 组：13.0±4.1 与 17.5±6.3 周；p<0.01）。然而，最终随访时两组的 Constant 评分无显著差异（L 组与 N 组：87.0±12.3 与 89.8±9.1）。
锁定和非锁定上钢板固定治疗移位的锁骨中段骨折的并发症发生率和临床结果相似。然而，锁定钢板的骨愈合时间更短。本研究表明，两种钢板固定系统均有效治疗移位的锁骨中段骨折。
治疗性，I 级。
