锁定加压钢板治疗锁骨远端NeerⅡB型骨折  

Stabilization of unstable distal clavicle fractures （Neer HB） with lateral clavicle anatomic locking compression plate

作　　者：蔡晓冰[1] 张立国[1] 竺伟[1] 伏青松[1] 贾建波[1] 顾广飞[1] 蔡郑东[1] 

机构地区：[1]同济大学附属第十人民医院骨科,上海200072

出　　处：《中华骨科杂志》2012年第7期659-663,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨采用锁骨远端前外侧锁定加压钢板（locking compressionplate，LCP）治疗锁骨远端NeerⅡB型骨折的疗效。方法回顾性分析2009年1月至2010年10月采用锁骨远端前外侧LCP治疗11例NeerⅡB型锁骨远端骨折的资料，男9例，女2例；年龄23-43岁，平均37．2岁；左侧5例，右侧6例；损伤至手术时间为24-72h，平均48h。骨折复位后将LCP置于锁骨远端上方，首先采用锁定螺钉固定锁骨远端，可根据骨折的长度选择3-6枚2．5mm的锁定螺钉，然后用3．5mm锁定螺钉固定骨折近端，无需修复喙锁韧带。采用美国肩肘外科医师学会（American Shoulderand Elbow Surgeons，ASES）评分评价术后肩关节功能。结果11例患者均获得随访，随访时间为9-12个月，平均10-3个月。X线片示锁骨骨折均愈合，其中10例在术后6个月内骨折愈合，1例在术后9个月骨折愈合。11例患者ASES评分为84-91分，平均89．1分，与健侧肩关节的功能评分相近。末次随访时，无一例发生钢板断裂、钢板周围骨折和肩袖损伤等并发症。结论采用锁骨远端前外侧LCP治疗NeerⅡB型锁骨远端骨折可以稳定锁骨远端，避免骨折不愈合和经肩关节固定锁骨远端的并发症。Objective To explore clinical and radiographic outcomes of unstable distal clavicle fractures （Neer IIB） fixed with lateral clavicle anatomic locking compression plate （LCP）. Methods Between January 2009 and October 2010, eleven consecutive patients with unstable fractures of the distal clavicle （Neer IIB） were treated using lateral clavicle anatomic LCP. There were 9 men and 2 women, with the mean age of 37.2 years （range, 23-43 years）. The right shoulder was involved in 6 patients and the left in 5 patients. The interval between injuries to operation was 24-72 h （mean, 48 h）. After fracture reduction, the plate was place on superior of the distal clavicle. According to the distal fragment length, 3 to 6 locking screws were carefully inserted, 3 locking screws were used to fix proximal fractures. Coracoelavieular liga- ment was not repaired. Functional recovery of the shoulder joint was assessed using the American Shoulder and Elbow Surgeons （ASES） rating scale score. Plain radiographs of clavicles were used to assess bony union. Results All the patients were followed up for 9 to 12 months （mean, 10.3 months）. Solid bony union was eventually achieved in all patients. The mean ASES scores were 89.1 （range, 84-91） on the injured side versus 96.2 （range, 94-100） on the contralateral side. No implant-related fracture, fixation failure and rotator cuff injury occurred. Conclusion Lateral clavicle anatomic LCP fixation in the treatment of distal clavicular fractures is a reliable and simple technique.

关 键 词：锁骨 骨折 骨折固定术 内 内固定器 

分 类 号：R687.3[医药卫生—骨科学]