胸锁关节外锁骨近端骨折的治疗  

Management of extra-articular medial clavicle fracture

作　　者：吴晓明[1] 李凡[1] 高伟[1] 桑伟林[1] 王秋根[1] 

机构地区：[1]上海交通大学附属第一人民医院骨科,200080

出　　处：《中华创伤骨科杂志》2013年第4期277-282,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨胸锁关节外锁骨近端骨折的治疗方法及疗效。方法对2007年1月至2009年8月收治的15例胸锁关节外锁骨近端骨折患者资料进行回顾性分析，男14例，女1例；年龄26～82岁，平均54．9岁。骨折根据Edinburgh分型：1A1型5例，1B1型10例。入院时损伤严重度评分为8～75分，平均26．1分。均为闭合性骨折，无神经、血管损伤。对于断端之间无骨皮质接触、锁骨节段性骨折或合并同侧肩胛骨骨折的9例患者，行切开复位钢板内固定术；另6例患者采用患肩悬吊制动等保守治疗。末次随访时采用Constant-Murley评分标准评定患肩功能。结果9例于术患者术后获12～18个月（平均15．3个月）随访。锁骨近端骨折均状解剖复位和骨性愈合，愈合时间为2～5个月，平均3个月。术玖随访时Constant-Murley评分为80～100分，平均95分；1例患者术后发生钢板断裂。6例保守治疗患者术后获10～13个月（平均12．2个月）随访，4例不稳定型锁骨近端骨折患者的Constant-Murley坪分为70～80分，平均77．5分；l例患者因肺部感染于伤后1个月死亡，结论对于不稳定型胸锁关节外锁骨近端骨折，通过手术恢复胸锁关节之间的解剖、重建上肩胛悬吊带复合体的稳定性，可以获得较好疗效。Objective To discuss clinical presentations and management of the extra-articular medial clavicle fracture.Methods Fifteen fractures of extra-articular medial clavicle were treated from January 2007 to August 2009.They were 14 men and one woman,with a mean age of 54.9 years （from 26 to 82 years）. By the Edinburgh classification,there were 5 cases of type 1A1 and 10 cases of 1B1.Their injury severity scores upon admission averaged 26. 1 points （from 8 to 75 points） .All fractures were closed, without injury to the nerves or vessels.Nine patients who had separation of bone ends without any apposition, segmental clavicle fracture or ipsilateral seapular fracture were treated by open reduction and internal fixation.The other 6 patients were treated （conservatively with immobilization of the suspensory complex. The functional recovery of the injured shoulder was evaluated by the Constant-Murley system at the last follow-up.Results The 9 operated patients were followed up for a mean duration of 15.3 months （from 12 1o 18 months） .All the operated fractures obtained anatomic reduction and bony union.The healing lime ranged from 2 to 5 months,averaging 3 months.The Constant-Murley scores ranged from 80 to 100 points （average, 95 points） .Plate breakage occurred in one case 8 weeks after the initial operation. The 6 patients treated conservatively obtained an average follow-up of 12.2 months（from 10 to 13 months）. Of them,4 unstable medial clavicle fractures had an average Constant-Murley score of 77.5 points （from 70 to 80 points） and one died from pneumonic infection one month after injury.Conclusion The surgical treatment is strongly recommended for the unstable medial clavicle fracture bicause it can restore the normal relationship of the sternodavicular joint as well as the integrity of the superior shoulder suspensory complex.

关 键 词：锁骨 肩胛骨 胸锁关节 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]