钩钢板与 T 型板治疗 Neer Ⅱ型锁骨远端骨折的比较：前瞻性配对对照队列研究。
Comparison of hook plate versus T-plate in the treatment of Neer type II distal clavicle fractures: a prospective matched comparative cohort study.
机构信息
Department of Orthopedic Surgery, Ayatollah Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Orthopedic Surgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
出版信息
J Orthop Surg Res. 2022 Jul 30;17(1):369. doi: 10.1186/s13018-022-03261-8.
BACKGROUND
This study aimed to compare the clinical and radiological outcomes of distal clavicle fracture fixation with a hook plate versus the standard non-locking T-plate for unstable Neer type II fractures.
METHODS
A prospective matched cohort study including two groups of hook plates and T-plates fixation was conducted in our two tertiary trauma centers. Patients with distal clavicle fractures Neer type II were assessed for union and the Constant-Murley score (CMS) at 1-, 3-, and 6-month follow-ups. Inadequate radiographic consolidation > 6 months after surgery was defined as non-union. Subscales of CMS, CMS, CMS, and CMS were also compared between groups. According to recommendations, the implant was removed after union confirmation in the hook plate at a planned second surgery.
RESULTS
Sixty consecutive patients were enrolled: 30 in the T-plate group and 30 in the hook plate group. CMS showed similar functional outcomes for T-plates and hook plates at all follow-ups (Month 6: 92.0 vs. 91.7, P = 0.45). However, on the month 1 follow-up, the T-plate group scored higher than the hook plate group for ROM and pain (CMS = 13.0 vs. 12.3, P = 0.03; CMS = 35.2 vs. 33.2, P = 0.002). Despite this, Pain, ROM, and other CMS domains were comparable between groups (P > 0.05). The mean time to union was 2.5 + 1.4 months for the T-plate group and 2.3 + 1.6 months for the hook plate group (P = 0.44). There was one fixation failure in each group and one periprosthetic fracture in the hook plate group (two revisions for the hook plates and one for T-plates, P = 1.00). Non-union and other complications were not observed.
CONCLUSION
Both surgical approaches resulted in full recovery and good function. However, in the hook plate group ROM and pain scores were lower at 1 month. Standard non-locking T-plates are a viable alternative to hook plates with low cost and promising outcomes for treating displaced distal clavicle fractures.
背景
本研究旨在比较钩钢板与标准非锁定 T 板治疗不稳定型 Neer II 型锁骨远端骨折的临床和影像学结果。
方法
在我们的两个三级创伤中心进行了一项前瞻性匹配队列研究，包括两组钩钢板和 T 板固定。对 Neer II 型锁骨远端骨折患者进行评估，以确定愈合情况，并在 1、3 和 6 个月随访时采用 Constant-Murley 评分（CMS）进行评估。术后 6 个月以上影像学未完全愈合定义为不愈合。比较两组间 CMS 的亚量表、CMS、CMS 和 CMS。根据建议，在钩钢板中确认愈合后，计划进行二次手术取出植入物。
结果
连续纳入 60 例患者：T 板组 30 例，钩钢板组 30 例。在所有随访时，CMS 显示 T 板和钩钢板的功能结果相似（6 个月时：92.0 比 91.7，P=0.45）。然而，在 1 个月随访时，T 板组的 ROM 和疼痛评分高于钩钢板组（CMS=13.0 比 12.3，P=0.03；CMS=35.2 比 33.2，P=0.002）。尽管如此，两组间疼痛、ROM 和其他 CMS 领域评分无差异（P＞0.05）。T 板组的愈合时间为 2.5±1.4 个月，钩钢板组为 2.3±1.6 个月（P=0.44）。每组均有 1 例固定失败，钩钢板组有 1 例假体周围骨折（钩钢板组进行了 2 次翻修，T 板组进行了 1 次翻修，P=1.00）。未观察到不愈合和其他并发症。
结论
两种手术方法均能完全恢复功能。然而，在钩钢板组，1 个月时 ROM 和疼痛评分较低。对于治疗移位性锁骨远端骨折，标准非锁定 T 板是钩钢板的一种可行替代方法，具有成本低和预后良好的特点。
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