Yoon Byungil, Kim Jae Yoon, Lee Jae-Sung, Jung Hyoung Seok
Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
Clin Shoulder Elb. 2018 Dec 1;21(4):227-233. doi: 10.5397/cise.2018.21.4.227. eCollection 2018 Dec.
The purpose of this study was to compare the radiologic results of patients who underwent surgery with a hook plate and a locking plate in distal clavicle fractures.
Sixty patients underwent surgical treatment for Neer type IIa, IIb, III, and V distal clavicle fracture. Twenty-eight patients underwent fracture fixation with a hook plate and 32 with a locking plate. Coracoclavicular distance was measured on standard anteroposterior radiographs before and after the surgery, and union was confirmed by radiograph or computed tomography taken at 6 months postoperatively. Other radiologic complications like osteolysis was also checked.
Bony union was confirmed in 59 patients out of 60 patients, and 1 patient in the hook plate group showed delayed union. Coracoclavicular distance was decreased more in the hook plate group after surgery (<0.01). After 6 weeks of the hook plate removal, the coracoclavicular distance was increased a little compared to before metal removal, but there was no difference compared to the contralateral shoulder. Eleven out of 28 patients (39.3%) showed osteolysis on the acromial undersurface in the hook plate group.
Both the hook plate group and the locking plate group showed satisfactory radiologic results in distal clavicle fractures. Both hook plate and locking plate could be a good treatment option if it is used in proper indication in distal clavicle fracture with acromioclavicular subluxation or dislocation.
本研究的目的是比较采用钩钢板和锁定钢板治疗锁骨远端骨折患者的影像学结果。
60例患者接受了手术治疗，骨折类型为Neer IIa型、IIb型、III型和V型锁骨远端骨折。28例患者采用钩钢板固定骨折，32例采用锁定钢板固定。在标准前后位X线片上测量手术前后的喙锁间距，并在术后6个月通过X线片或计算机断层扫描确认骨折愈合情况。还检查了其他影像学并发症，如骨质溶解。
60例患者中有59例确认骨折骨性愈合，钩钢板组有1例出现延迟愈合。钩钢板组术后喙锁间距减小更明显（<0.01）。取出钩钢板6周后，喙锁间距比取出金属前略有增加，但与对侧肩部相比无差异。钩钢板组28例患者中有11例（39.3%）出现肩峰下骨质溶解。
钩钢板组和锁定钢板组在锁骨远端骨折的影像学结果方面均令人满意。如果在有肩锁关节半脱位或脱位的锁骨远端骨折中正确应用，钩钢板和锁定钢板都是很好的治疗选择。
