Nyholm Anne Marie, Witten Adam, Barfod Kristoffer Weisskirchner
Department of Orthopaedics, Herlev/Gentofte University Hospital, Hellerup, Denmark.
Department of Orthopedic Surgery, Sports Orthopedic Research Center - Copenhagen (SORC-C), Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
JSES Rev Rep Tech. 2024 Feb 17;4(2):141-145. doi: 10.1016/j.xrrt.2024.01.008. eCollection 2024 May.
A clavicle fracture often changes the mechanical axes of the shoulder girdle due to displacement and shortening, potentially leading to scapular protraction and decreased subacromial space. If protraction of the scapula is a major risk factor for developing subacromial pain syndrome (SAPS), a previous clavicle fracture could increase the risk of later SAPS. The purpose of this study was to investigate if a previous clavicle fracture correlates with a higher occurrence or earlier diagnosis of SAPS.
In this retrospective case-control study with data from the Danish National Patient Register, all persons aged 18-60 years, with any hospital contact due to a clavicle fracture (DS420) between January 1, 1996, and December 31, 2005, were identified as cases. For each case, five controls, matched on age and sex, were identified. Primary outcome was the first hospital contact with a SAPS diagnosis (DM751-755) registered more than 180 days following the fracture. Follow-up was until November 01, 2021.
21.973 cases and 109.865 controls were included. The incidence of clavicle fractures was 76 fractures per 100.000 persons per year. Twenty-three percent were female. 1.640 (7.46%) cases and 8.072 (7.35%) controls received a SAPS diagnosis within the following 15-25 years, demonstrating no significant difference in the occurrence of SAPS ( = .56). The mean time from fracture to SAPS diagnosis was shorter for cases compared to controls (4040 vs. 4442 days, < .001), and cases were slightly younger when receiving the diagnosis (51.3 vs. 53.6 years, < .001). 1614 cases underwent surgical fixation. This subgroup had a statistically significant higher occurrence of later SAPS diagnosis (205 cases, 13%, < .001).
Persons with a previous clavicle fracture did not have an increased occurrence of receiving a SAPS diagnosis compared to matched controls. However, the diagnosis was given 1-2 years earlier for people with a previous fracture. Based on these findings, no strong argument for protraction of the scapula as a major risk factor for the development of SAPS was found.
锁骨骨折常因移位和缩短而改变肩胛带的机械轴，可能导致肩胛骨前伸和肩峰下间隙减小。如果肩胛骨前伸是发生肩峰下疼痛综合征（SAPS）的主要危险因素，那么既往锁骨骨折可能会增加日后发生SAPS的风险。本研究的目的是调查既往锁骨骨折是否与SAPS的更高发生率或更早诊断相关。
在这项基于丹麦国家患者登记处数据的回顾性病例对照研究中，所有在1996年1月1日至2005年12月31日期间因锁骨骨折（DS420）而有任何医院就诊记录的18至60岁人员被确定为病例。对于每个病例，确定五名年龄和性别匹配的对照。主要结局是骨折后180天以上首次因SAPS诊断（DM751 - 755）而进行的医院就诊记录。随访至2021年11月1日。
纳入了21973例病例和109865名对照。锁骨骨折的发生率为每年每10万人中有76例骨折。23%为女性。1640例（7.46%）病例和8072例（7.35%）对照在随后的15至25年内被诊断为SAPS，表明SAPS的发生率无显著差异（P = 0.56）。与对照相比，病例从骨折到SAPS诊断的平均时间更短（4040天对4442天，P < 0.001），且病例在接受诊断时年龄稍小（51.3岁对53.6岁，P < 0.001）。1614例病例接受了手术固定。该亚组后期SAPS诊断的发生率在统计学上显著更高（205例，13%，P < 0.001）。
与匹配的对照相比，既往有锁骨骨折的人接受SAPS诊断的发生率没有增加。然而，既往有骨折的人诊断时间要早1至2年。基于这些发现，未发现有充分证据支持肩胛骨前伸是SAPS发生的主要危险因素。
