单板与双板治疗粉碎性锁骨骨折的比较:辅助板是否可靠?
Single-plate versus double-plate comparison in the surgical treatment of comminuted clavicle fractures: Is the secondary plate reliable?
机构信息
Department of Orthopaedic and Traumatology, Konya City Hospital, Konya, Turkey.
Department of Orthopaedic and Traumatology, Necip Fazil City Hospital, Kahramanmaras, Turkey.
出版信息
Medicine (Baltimore). 2023 Dec 22;102(51):e36711. doi: 10.1097/MD.0000000000036711.
The objective of this study is to retrospectively assess the use of single-plate (SP) and double-plate (DP) fixation in the open reduction and internal fixation of comminuted clavicle fractures, focusing on fracture union and complications. We retrospectively evaluated comminuted diaphyseal clavicle fractures (Arbeitsgemeinschaft für Osteosynthesefragen type 15.B1-3) treated with open reduction and internal fixation and having a minimum 1-year follow-up. Two patient cohorts were identified: DP (utilizing a superiorly located clavicle-specific plate and an anteriorly located tubular plate) and SP (utilizing a superiorly located clavicle-specific plate). These groups were compared in terms of union time, peri-incisional numbness, implant irritation, return to work time, union rates, re-operation rates, Disabilities of Arm, Shoulder and Hand (DASH), and American Shoulder and Elbow Surgeons (ASES) scores. The study included 27 SP and 23 DP patients meeting the inclusion criteria. There was no significant difference between the 2 cohorts in terms of union time, peri-incisional numbness, implant irritation, return to work time, union rates, re-operation rates, DASH, and ASES scores at the end of the first year (P = .889, P = 1.00, P = .122, P = 1.00, P = 1.00, P = .493, P = .736, P = .762, P = .937 respectively). However, it was observed that the DP group showed a significantly earlier return to work time and better DASH scores at 3rd and 6th months, whereas the SP group exhibited significantly better ASES scores at 3rd and 6th months (P = .034, P = .016, P = .032, P = .036, P = .021, respectively). No significant difference was observed in terms of union and complications in acute clavicle fractures treated with SP and DP fixation. The DP group demonstrated an earlier return to work and superior early functional scores compared to the SP group. Our findings suggest that a secondary plate can be reliably used, particularly in situations where clavicle fracture fixation is insufficient or in cases of comminuted clavicle fractures.
本研究旨在回顾性评估单钢板(SP)和双钢板(DP)固定在粉碎性锁骨骨折切开复位内固定中的应用,重点关注骨折愈合和并发症。我们回顾性评估了接受切开复位内固定治疗且随访时间至少 1 年的粉碎性锁骨骨干骨折( Arbeitsgemeinschaft für Osteosynthesefragen 15.B1-3 型)。确定了两个患者队列:DP(使用位于锁骨上方的专用钢板和位于前方的管状钢板)和 SP(使用位于锁骨上方的专用钢板)。比较两组患者的愈合时间、切口周围麻木、植入物刺激、重返工作时间、愈合率、再次手术率、手臂、肩部和手部残疾(DASH)和美国肩肘外科医师协会(ASES)评分。该研究纳入了 27 例 SP 和 23 例 DP 患者,均符合纳入标准。两组患者在愈合时间、切口周围麻木、植入物刺激、重返工作时间、愈合率、再次手术率、DASH 和 ASES 评分方面无显著差异在第一年结束时(P=0.889,P=1.00,P=0.122,P=1.00,P=1.00,P=0.493,P=0.736,P=0.762,P=0.937)。然而,观察到 DP 组在第 3 个月和第 6 个月时的重返工作时间更早,DASH 评分更好,而 SP 组在第 3 个月和第 6 个月时的 ASES 评分更高(P=0.034,P=0.016,P=0.032,P=0.036,P=0.021)。SP 和 DP 固定治疗急性锁骨骨折在骨折愈合和并发症方面无显著差异。与 SP 组相比,DP 组更早地恢复工作,且早期功能评分更高。我们的研究结果表明,特别是在锁骨骨折固定不足或粉碎性锁骨骨折的情况下,可以可靠地使用辅助钢板。