Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Shenzhen, 518046, China.
J Orthop Surg Res. 2021 May 8;16(1):301. doi: 10.1186/s13018-021-02438-x.
Congenital pseudoarthrosis of the clavicle (CPC) is an uncommon entity. Owing to its scarce presentation, treatment of this disorder has not been well established. This study aimed (1) to compare surgical treatment methods that included excision of pseudoarthrosis and iliac crest bone graft and fixate with either the elastic stable intramedullary nail (ESIN) or K-wires or plate and screws, and (2) to assess the clinical outcomes of two different surgical methods.
A multi-central retrospective study was performed between 2013 and 2017 in four tertiary teaching hospitals. Fifteen clavicles of 11 children were identified as CPC. All patients underwent pseudarthrosis resection and iliac crest bone autograft. They were divided into two groups as per the surgical treatment they underwent-plate stabilization as group A and elastic stable intramedullary nailing (ESIN) or K-wires as group B. Nine clavicles in 6 patients in group A and 6 clavicles in 5 patients in group B, were included. The Quick Disabilities of the Arm and Shoulder (QuickDASH) score was used to assess patients' satisfaction and function following treatment at each follow-up.
There were eight boys and three girls, with an average age of 4.7 years. All patients, except one with intellectual impairments, had radiological healing. Implant removal time was significantly shorter in group B compared to group A. No statistically significant differences existed in terms of age at surgery, time of radiological healing, complication, and clinical outcome between different groups.
Surgical resection of pseudoarthrosis with an iliac crest bone graft was an effective means of surgical treatment in CPC. However, ESIN or K-wires can achieve shorter union time compared to the plate. Hence, surgical treatment is recommended for congenital pseudarthrosis of clavicular in pediatric patients.
Retrospective comparative study; Level III.
先天性锁骨假关节（CPC）是一种罕见的疾病。由于其罕见的表现，这种疾病的治疗方法尚未得到很好的确立。本研究旨在：（1）比较包括假关节切除和髂嵴骨移植以及使用弹性稳定髓内钉（ESIN）或 K 线或钢板和螺钉固定的两种手术治疗方法；（2）评估两种不同手术方法的临床效果。
在 2013 年至 2017 年期间，在四家三级教学医院进行了一项多中心回顾性研究。共确定了 11 名儿童的 15 例锁骨 CPC。所有患者均行假关节切除和髂嵴骨自体移植。根据手术治疗方法将患者分为两组，钢板固定组（A 组）和弹性稳定髓内钉（ESIN）或 K 线组（B 组）。A 组中 6 例 9 例锁骨，B 组中 5 例 6 例锁骨。使用 Quick Disabilities of the Arm and Shoulder（QuickDASH）评分评估患者在每次随访时的治疗满意度和功能。
8 例为男孩，3 例为女孩，平均年龄为 4.7 岁。除 1 例智力障碍外，所有患者均有影像学愈合。B 组的植入物去除时间明显短于 A 组。不同组之间在手术年龄、影像学愈合时间、并发症和临床结果方面无统计学差异。
手术切除假关节并植骨髂嵴是 CPC 手术治疗的有效方法。然而，ESIN 或 K 线可以比钢板更快地实现愈合。因此，建议对小儿患者的先天性锁骨假关节进行手术治疗。
回顾性比较研究；三级。
