锁骨中段复杂骨折重建钢板锁定与非锁定的选择  

The Choice between Locking and Nonlocking Reconstruction Plate when Treating Complicated Clavicle Midshaft Fracture

作　　者：赵燕鹏[1] 张立海[1] 唐佩福[1] 梁向党[1] 陈华[1] 郝明[1] 王岩[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《实用骨科杂志》2013年第8期698-701,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨锁骨中段复杂骨折采用重建钢板时,锁定与非锁定固定模式的临床疗效差异。方法回顾性分析116例闭合性锁骨中段复杂骨折(AO/OTA-B3型、C型)的临床病例,均使用同一种重建钢板固定。锁定模式固定组64例,非锁定模式固定组52例。术后随访13～46个月,平均27.8个月。比较两组在骨折愈合时间、延迟愈合和不愈合、内固定失效、Constant-Murley评分的差异。结果锁定和非锁定组的平均骨折愈合时间分别为13.9周和12.7周(P>0.05)。两组骨折愈合率分别为98.4%和98.1%(P>0.05)。锁定组有3例发生延迟愈合,非锁定组为0例(P<0.05)。两组均有1例患者骨折不愈合并发生钢板断裂。非锁定组有1例螺钉松动拔出,但骨折最终于术后5个月愈合。锁定组的Constant-Murley评分平均为94.2分,非锁定组平均为93.3分(P>0.05)。结论对于锁骨中段B3和C型这类复杂骨折,重建钢板采用锁定模式虽然能提供更强的稳定性,但在促进骨折愈合、增加骨折愈合率、改善肩关节功能、减少内固定失效等方面,与非锁定模式相比并无明显优势,同时可能导致延迟愈合,故不推荐将锁定固定作为常规选择。Objective To compare the clinical outcome of the reconstruction plate when used in two different ways to treat complicated clavicle midshaft fracture. Methods One hundred and sixteen patients with complicated clavicle midshaft fracture classified as either type B3 or type C, according to the AO/OTA classification ,were treated by internal fixation with the identical reconstruction plate. Sixty-four of the overall patients were treated with the identical reconstruction plate in a locking way, while the rest fifty-two patients were in a nonlocking way. The mean time to union, incidence of nonunion or delayed union, hardware failure and Constant Mudey Score were observed and analyzed to make comparisons between the two groups. Results The mean time to union was 13.9 weeks in the locking group and 12.7 weeks in the nonloeking group （P 〉 0.05 ） ,while the mean union rate was 98.4% and 98.1% respectively （P 〉0.05）. In the locking group there were delayed union in 3 cases, nonunion in 1 case, and plate breakage in 1case. The complications in the nonloeking group were delayed union in 0 cases, nonunion in 1 case, plate breakage in 1case, and screw loosening in 1 case（ P 〈 0.05 ）. Conclusion Compared to nonlocking, the reconstruction plate that was used in the locking way didn＇ t show any advantages in decreasing the time to union, increasing the rate of union, promoting the function of shoulder and reducing the incidence of hardware failure. On the contrary, when the reconstruction plate was used in a locking way, rather than a nonloeking way, it might lead the fracture to delayed union. We don＇ t recommend to choose the locking plate as a prior option to the nonlocking plate to treat complicate clavicle midshaft fracture.

关 键 词：锁骨骨折 重建钢板 锁定 非锁定 内固定术 

分 类 号：R683.41[医药卫生—骨科学]