Department of Orthopedic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Orthop Surg. 2021 Apr;13(2):451-457. doi: 10.1111/os.12893. Epub 2021 Jan 22.
To describe a new method which involves anatomical distal clavicle plate fixation and titanium alloy cable system-augmented coracoclavicular ligament reconstruction to manage Neer type IIb distal clavicle fracture.
Between January 2013 and June 2018, 28 patients with acute Neer type IIb lateral clavicle fracture were treated by a new method - precontoured locking compressive distal clavicular plate fixation of the fracture combined with titanium alloy cable system-augmented reconstruction of the coracoclavicular ligament. There were 11 females and 17 males treated in this way. There were 15 cases of the right side and 13 of the left. The mean age of the patients was 48.5 years (range, 18-78 years). The mean time from injury to surgery was 3.9 days (range, 1-7 days). After completing the preoperative examinations and evaluations, surgeries were performed for all these patients, anatomical distal clavicle plates were used for fractures, and titanium alloy cables were implanted for the augmented reconstruction of coracoclavicular ligaments. Postoperative protocols, including arm sling management and rehabilitative activities, were unified and recommended to all the patients. These patients were followed up for at least 1 year. The mean duration of postoperative follow-up was 23.3 months (range, 12-52 months). At the last follow-up, the coracoclavicular distances were recorded and shoulder functional outcomes were assessed by the Constant scores and the Fudan University Shoulder Scores (FUSSs) questionnaires.
Radiographic bony unions were achieved in all patients within 20 weeks. Functional and radiographic outcomes were retrospectively evaluated. The mean coracoclavicular distance was 9.61 ± 0.61 mm on the injured side vs 9.62 ± 0.57 mm on the contralateral uninjured side. The mean Constant score and mean FUSS were 90.1 ± 6.6 (range, 68-98) and 86.1 ± 7.2 (range, 64-95) respectively, which indicating good restoration of function and high level of satisfaction for both the patients and their physical therapists. There were a few major complications, including one delayed healing of the skin, one severe shoulder stiffness, three incidences of moderate shoulder stiffness, and five incidences of symptomatic hardware. There is no deep infections, neurovascular injuried, delayed union or nonunion, peri-implant fracture, loss of reduction, implant malposition or failure, or other severe complications.
This combined method for the treatment of Neer type IIb distal clavicle fracture could yield high bony union rate, good functional outcome, and low complication rate. Further prospective randomized controlled studies are needed to confirm the benefits of this method of treatment.
描述一种新的方法，涉及解剖远端锁骨板固定和钛合金缆线系统增强喙锁韧带重建，以治疗 Neer Ⅱ b 型远端锁骨骨折。
2013 年 1 月至 2018 年 6 月，采用新方法治疗急性 Neer Ⅱ b 型外侧锁骨骨折 28 例，即预塑形锁定加压远端锁骨板固定骨折，钛合金缆线系统增强喙锁韧带重建。其中女 11 例，男 17 例；右侧 15 例，左侧 13 例；患者年龄 1878 岁，平均 48.5 岁；受伤至手术时间 17 天，平均 3.9 天。所有患者术前检查评估后均行手术治疗，骨折用解剖远端锁骨板固定，喙锁韧带增强重建用钛合金缆线。术后统一并推荐所有患者使用臂吊带管理和康复活动。这些患者随访至少 1 年，术后随访时间平均 23.3 个月（12~52 个月）。末次随访时，记录喙锁间距，采用 Constant 评分和复旦大学肩关节评分（FUSS）问卷评估肩关节功能。
所有患者在 20 周内均获得影像学骨愈合。回顾性评估功能和影像学结果。患侧喙锁间距为 9.61±0.61mm，对侧未受伤侧为 9.62±0.57mm。Constant 评分和 FUSS 平均分别为 90.1±6.6（6898）和 86.1±7.2（6495），提示患者及其物理治疗师对功能恢复和满意度均较高。少数主要并发症包括：1 例皮肤愈合延迟，1 例严重肩关节僵硬，3 例中度肩关节僵硬，5 例有症状的内固定物。无深部感染、神经血管损伤、延迟愈合或不愈合、植入物周围骨折、复位丢失、植入物位置不当或失败或其他严重并发症。
这种 Neer Ⅱ b 型远端锁骨骨折的综合治疗方法可获得较高的骨愈合率、良好的功能结果和较低的并发症发生率。需要进一步的前瞻性随机对照研究来证实这种治疗方法的益处。
