Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, Nice, France.
Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, USA.
Int Orthop. 2022 Nov;46(11):2577-2583. doi: 10.1007/s00264-022-05470-6. Epub 2022 Jun 15.
There is no consensus on the type of surgical treatment of congenital pseudarthrosis of the clavicle due to its rarity. The purpose of this study is to provide evidence in favor of a surgical technique and to explore factors correlated with bone consolidation.
Systematic review of the literature and an analysis of the data for each subject, including all available subjects from the published series and clinical cases since 1990. Fisher's exact tests or T-tests were used to evaluate the effect of independent variables (age at surgery and type of treatment) on bone healing.
The literature search provides 305 articles; 30 were selected, reporting 191 patients and 194 clavicles. One hundred and fifty-one clavicles were operated on at a mean age of nine years and four months (from 8 months to 21 years). Thirteen clavicles (8, 6%) had not consolidated at the last follow-up. Concerning the type of fixation, the rate of healing was similar for plates and pins (p = 0.27). The rate of consolidation was higher with autograft than with allograft, xenograft, or no graft (p = 0.00001), and was 100% for vascularized graft. The mean age at surgery was higher for patients who healed at the last follow-up (118 vs. 61 months, p = 0.001).
In the event of surgical indication for congenital pseudarthrosis of the clavicle, it is recommended to perform autograft and stable fixation (level 4) after seven years old (level 4).
由于先天性锁骨假关节的罕见性，对于其手术治疗类型尚未达成共识。本研究旨在提供支持某种手术技术的证据，并探讨与骨愈合相关的因素。
对文献进行系统回顾，并对每个病例的数据进行分析，包括自 1990 年以来已发表系列中的所有可用病例和临床病例。使用 Fisher 确切检验或 T 检验评估独立变量（手术时的年龄和治疗类型）对骨愈合的影响。
文献检索提供了 305 篇文章；选择了 30 篇，报告了 191 名患者和 194 例锁骨。151 例锁骨在平均 9 岁 4 个月（8 个月至 21 岁）时接受手术。在最后一次随访时，有 13 例锁骨（8%）未愈合。关于固定类型，钢板和钢针的愈合率相似（p=0.27）。与同种异体、异种或无移植物相比，自体移植物的愈合率更高（p=0.00001），而带血管化移植物的愈合率为 100%。在最后一次随访时愈合的患者的手术年龄更高（118 与 61 个月，p=0.001）。
在存在先天性锁骨假关节手术指征的情况下，建议在 7 岁后进行自体移植物和稳定固定（4 级）（4 级）。
