Jubel Axel, Knopf Maximilian, Jubel Jil Marie, Herbst Hannah, Antonie Moritz
Klinik für Unfall- und Wiederherstellungschirurgie, Eduardus-Krankenhaus Köln, Custodisstr. 3-17, 50679, Köln, Deutschland.
Department Medizin, Danube Private University, Krems, Österreich.
Unfallchirurgie (Heidelb). 2024 Nov;127(11):776-782. doi: 10.1007/s00113-024-01465-7. Epub 2024 Jul 25.
After conservative treatment nonunion (pseudarthrosis) of the clavicle can be observed approximately 10 times more frequently (15-24%) than after surgical treatment (1.4%). Risk factors include the fracture location, displacement, fracture type, sex, the severity of the accident and refractures. The diagnosis of pseudarthrosis of the clavicle can be made by a thorough medical history, clinical examination and imaging procedures. The main symptom is pain, often accompanied by malalignment, instability, neurological symptoms and restricted mobility of the affected shoulder. The diagnosis is confirmed by X‑ray images and, if necessary, a computed tomography (CT) scan. Pseudoarthrosis is classified according to the morphological appearance in X‑ray images and the cause. A differentiation is made between vital and nonvital pseudarthroses. Only symptomatic pseudarthrosis requires treatment. Nonoperative methods, such as magnetic field therapy or ultrasound are minimally effective. Surgical interventions are indicated for pain, movement restrictions or neurovascular problems. The goals of surgical treatment are to restore the vitality, bone length and stability through angular stable osteosynthesis. In cases of surgical pretreatment the anteroinferior plate position offers a good alternative to the superior plate position. In some cases double plating osteosynthesis can be indicated. Autogenous bone material, allogeneic substitute material and vascularized grafts are used for bony defects. Surgical treatment shows high rates of healing but also carries an increased risk of infection.
保守治疗后，锁骨骨不连（假关节）的发生率约为手术治疗后的10倍（15 - 24%），而手术治疗后的发生率为1.4%。风险因素包括骨折部位、移位情况、骨折类型、性别、事故严重程度和再骨折。锁骨假关节的诊断可通过详细的病史、临床检查和影像学检查来做出。主要症状是疼痛，常伴有畸形、不稳定、神经症状以及患侧肩部活动受限。通过X线图像确诊，必要时进行计算机断层扫描（CT）。假关节根据X线图像的形态外观和病因进行分类。分为有活力和无活力的假关节。只有有症状的假关节才需要治疗。非手术方法，如磁场疗法或超声，效果甚微。手术干预适用于疼痛、活动受限或神经血管问题。手术治疗的目标是通过角稳定接骨术恢复骨活力、骨长度和稳定性。在手术预处理的情况下，前下钢板位置是上钢板位置的良好替代方案。在某些情况下，可采用双钢板接骨术。自体骨材料、同种异体替代材料和带血管移植物用于骨缺损。手术治疗愈合率高，但感染风险也增加。
