前瞻性评估移位性锁骨中段骨折的早期功能恢复情况，无论是否手术。

Prospective evaluation of early functional recovery of displaced fractures of the middle third of the clavicle whether operated or not.

机构信息

Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, assistance main, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.

出版信息

Orthop Traumatol Surg Res. 2021 Feb;107(1):102768. doi: 10.1016/j.otsr.2020.102768. Epub 2020 Dec 24.

DOI:10.1016/j.otsr.2020.102768

PMID:33348044

Abstract

INTRODUCTION

Several studies have analyzed the functional recovery after plate fixation of a displaced fracture of the middle third of the clavicle beyond the 6th week. The aim of this study was to assess the early functional recovery in the first 6 weeks, which has not yet been investigated.

HYPOTHESIS

Functional recovery in the first 6 weeks after surgical treatment is better than in the first 6 weeks of functional (non-operative) treatment.

METHODS

Any patient who had a closed displaced fracture of the middle third of the clavicle - Edinburgh types 2B1 or 2B2 - was informed of the treatment options within a week of their fracture: surgical fixation by anatomic plate or functional treatment. A QuickDASH score was filled out weekly for 6 weeks and at 3 and 6 months. Similarly, the Constant score was determined at 3 and 6 weeks and at 3 and 6 months. Any complications were documented and time to union was determined.

RESULTS

Sixty-five fractures in 65 patients were followed for 6 months. Twenty-six patients chose surgical treatment (S) and 39 chose functional treatment (F). The Constant and QuickDASH scores were significantly better in the S group from the 2nd to the 6th week. At 3 weeks, we found a Constant score of 57.7 in group F versus 74.9 in group S (p<0.01) and a QuickDASH of 55.9 in group F versus 27.4 in group S (p<0.001). At 6 weeks, the Constant score was 71.3 versus 86.1 (p<0.001) and the QuickDASH was 28.3 versus 10.6 (p<0.01), respectively. At 3 and 6 months, the recovery was comparable in both groups for these two scores. Return to work was earlier in the S group (34.3 versus 59.7 days; p<0.05).

DISCUSSION

This is the first study reporting the functional results during the first 6 weeks after a displaced fracture of the middle third of the clavicle in adults. Further studies should be conducted to better identify target patients for whom fracture fixation may be beneficial.

CONCLUSION

This study supports open reduction and internal fixation with an anatomical plate of displaced fractures of the middle third of the clavicle since the functional recovery is better in the first 6 weeks.

LEVEL OF EVIDENCE

III; prospective case-control study.

摘要

简介

已有多项研究分析了超过第 6 周后锁骨中段移位骨折的钢板固定后的功能恢复情况。本研究旨在评估前 6 周的早期功能恢复情况，而这一点尚未得到研究。

假设

手术治疗后前 6 周的功能恢复优于前 6 周的非手术（功能）治疗。

方法

在骨折后一周内，任何患有闭合性移位性锁骨中段骨折（爱丁堡 2B1 或 2B2 型）的患者均被告知治疗选择：解剖钢板固定或功能治疗。在 6 周内每周填写一次 QuickDASH 评分，并在 3 个月和 6 个月时进行评分。同样，在 3 周和 6 周以及 3 个月和 6 个月时确定 Constant 评分。记录任何并发症并确定愈合时间。

结果

65 名患者的 65 处骨折随访 6 个月。26 名患者选择手术治疗（S），39 名患者选择功能治疗（F）。从第 2 周到第 6 周，S 组的 Constant 和 QuickDASH 评分明显更好。在 3 周时，我们发现 F 组的 Constant 评分为 57.7，而 S 组为 74.9（p<0.01），QuickDASH 评分为 55.9，而 S 组为 27.4（p<0.001）。在 6 周时，Constant 评分为 71.3 与 86.1（p<0.001），QuickDASH 评分为 28.3 与 10.6（p<0.01）。在 3 个月和 6 个月时，两组的这两个评分的恢复情况相当。S 组的恢复工作时间更早（34.3 与 59.7 天；p<0.05）。