Kim Dong Jin, Lee Yoon Min, Yoon Eun Ji, Sur Yoo Joon
Department of Orthopedic Surgery, Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Uijeongbu St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Orthop J Sports Med. 2022 Mar 24;10(3):23259671221086673. doi: 10.1177/23259671221086673. eCollection 2022 Mar.
There remains no consensus regarding which repair technique provides the most optimal results for unstable distal clavicle fractures.
To compare radiologic and clinical outcomes between locking plate fixation and anatomic coracoclavicular (CC) ligament reconstruction for patients with unstable distal clavicle fractures.
Cohort study; Level of evidence, 3.
The study included 41 patients with Neer type 2B distal clavicle fracture. In group A (n = 15), patients were treated using CC ligament reconstruction with autologous palmaris longus tendon, artificial tape, and Steinmann pin fixation; in group B (n = 26), patients were treated using anatomic locking plate fixation. All patients had a minimum 2 years of follow-up. CC distance and arthrosis of the acromioclavicular joint were assessed radiographically. Clinical outcomes-including range of motion, visual analog scale for pain, American Shoulder and Elbow Surgeons rating scale, and Constant score-were compared between the groups using the paired Student test and Fisher exact test.
Bone union was attained in all patients. In both groups, the CC distance decreased significantly from presurgery to final follow-up: group A, from 16.25 ± 4.75 to 7.66 ± 2.61 mm ( < .001); group B, from 17.3 ± 4.07 to 9.33 ± 2.01 mm ( < .001). The final CC distance was significantly greater in group B (7.66 vs 9.33 mm in groups A and B, respectively; = .028). Osteoarthritis of the acromioclavicular joint occurred in 13 of 41 patients (3 in group A and 10 in group B). At final follow-up, there was no statistical significance between the groups in range of motion, and clinical outcome scores were satisfactory in both groups, with no statistical difference between them.
Anatomic locking plate and anatomic reconstruction of the CC ligament showed good clinical results, so both techniques can be considered reliable for restoring stability. However, CC ligament reconstruction had better CC distance on radiologic assessment and did not require removal surgery, so it may be the preferable surgical option to treat unstable distal clavicle fractures (Neer type 2B).
对于不稳定的锁骨远端骨折，哪种修复技术能提供最理想的效果尚无共识。
比较锁定钢板固定与解剖学喙锁（CC）韧带重建治疗不稳定锁骨远端骨折患者的影像学和临床结果。
队列研究；证据等级，3级。
该研究纳入41例Neer 2B型锁骨远端骨折患者。A组（n = 15）患者采用自体掌长肌腱、人工带和斯氏针固定进行CC韧带重建治疗；B组（n = 26）患者采用解剖锁定钢板固定治疗。所有患者均进行了至少2年的随访。通过影像学评估CC间距和肩锁关节的关节炎情况。使用配对t检验和Fisher精确检验比较两组之间的临床结果，包括活动范围、疼痛视觉模拟量表、美国肩肘外科医师评分量表和Constant评分。
所有患者均实现了骨愈合。两组患者的CC间距从术前到最终随访均显著减小：A组从16.25±4.75毫米降至7.66±2.61毫米（P <.001）；B组从17.3±4.07毫米降至9.33±2.01毫米（P <.001）。B组的最终CC间距显著更大（A组和B组分别为7.66毫米和9.33毫米；P = 0.028）。41例患者中有13例发生了肩锁关节骨关节炎（A组3例，B组10例）。在最终随访时，两组之间的活动范围无统计学差异，两组的临床结果评分均令人满意，且两组之间无统计学差异。
解剖锁定钢板和CC韧带的解剖重建均显示出良好的临床效果，因此这两种技术在恢复稳定性方面均可视为可靠。然而，CC韧带重建在影像学评估中具有更好的CC间距，且无需取出手术，因此它可能是治疗不稳定锁骨远端骨折（Neer 2B型）的更优手术选择。
