Central Institute of Orthopedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India.
Central Institute of Orthopedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India.
Chin J Traumatol. 2023 Mar;26(2):101-105. doi: 10.1016/j.cjtee.2022.04.005. Epub 2022 Apr 16.
Various surgical modalities are available to treat Neer types 2 and 5 unstable fractures of lateral end clavicle but none of them are standardized. Arthroscopic fixation of the displaced lateral end clavicle fractures provides good short-term results but mid- to long-term outcomes are not available. The purpose of this study was to show the mid- to long-term radiological and functional outcomes of these fractures treated arthroscopically by a TightRope device, and to show the complications associated with this procedure.
A retrospective study was conducted over 2 years from January 2014 to December 2015 with a minimum 5-year follow-up. Active patients aged 18-50 years with acute (less than 3 weeks) displaced fracture of lateral end of the clavicle, with a minimum 5-year follow-up were included in the study. Patients with associated fractures of the proximal humerus, glenoid, scapula and acromioclavicular joint injuries were excluded from the study along with open fractures and neurovascular injuries. The outcomes were assessed by objective (complications and radiographic examination) and subjective criteria (quick disabilities of the arm, shoulder and hand score, the Constant-Murley score and the visual pain analogue scale). The data were analyzed by SPSS version 21.0.
Totally, 42 patients were operated during the study period and 37 were available with a minimum 5-year follow-up. Thirty were male and 7 were female with a mean age of 29.5 years and a mean follow-up of 6.1 years. The mean quick disabilities of the arm, shoulder and hand score was 68.2 ± 4.6 preoperatively and 1.27 ± 2.32 at final follow-up (p < 0.001); the mean visual pain analogue scale score was 6.85 ± 2.2 preoperatively and 0.86 ± 1.60 at final follow-up (p < 0.001). The average Constant-Murley score was 93.38 ± 3.25 at the end of the follow-up. There were 2 fixation failures, with established non-union and 3 patients developed radiographic acromioclavicular joint arthritis.
Arthroscopic TightRope fixation of displaced lateral end clavicular fractures provides good radiological and functional outcomes at mid- to long-term follow-up. With the low complication rates and high patient satisfaction, this technique can be considered as a primary option in the surgical treatment of these fractures.
有多种手术方法可用于治疗 Neer 型 2 型和 5 型不稳定外侧锁骨端骨折，但均未标准化。关节镜下固定移位的外侧锁骨端骨折可获得良好的短期效果，但中至长期效果尚不清楚。本研究的目的是展示通过 TightRope 装置关节镜治疗这些骨折的中至长期影像学和功能结果，并展示与该手术相关的并发症。
回顾性研究于 2014 年 1 月至 2015 年 12 月进行，随访时间至少为 5 年。纳入研究的患者为年龄在 18-50 岁之间的急性（<3 周）外侧锁骨端移位骨折的活动患者，随访时间至少为 5 年。伴有肱骨近端、肩胛盂、肩胛骨和肩锁关节损伤的相关骨折、开放性骨折和神经血管损伤的患者被排除在研究之外。通过客观（并发症和影像学检查）和主观标准（手臂、肩部和手部功能障碍快速评分、Constant-Murley 评分和视觉疼痛模拟评分）评估结果。数据采用 SPSS 21.0 版进行分析。
研究期间共对 42 例患者进行了手术，37 例患者获得了至少 5 年的随访。其中 30 例为男性，7 例为女性，平均年龄为 29.5 岁，平均随访时间为 6.1 年。术前手臂、肩部和手部功能障碍快速评分平均为 68.2±4.6，末次随访时为 1.27±2.32（p<0.001）；术前视觉疼痛模拟评分平均为 6.85±2.2，末次随访时为 0.86±1.60（p<0.001）。末次随访时平均 Constant-Murley 评分为 93.38±3.25。有 2 例固定失败，出现明确的骨不连，3 例患者发生影像学肩锁关节关节炎。
关节镜下 TightRope 固定移位的外侧锁骨端骨折可获得良好的中至长期影像学和功能结果。该技术并发症发生率低，患者满意度高，可作为此类骨折的首选手术治疗方法。
