Neer Ⅱ锁骨远端骨折的治疗(英文)  

Treatment for Neer type Ⅱ fractures of the distal clavicle

作　　者：江涛[1] 苏海涛[1] 朱兴阳[1] 刘子桃[1] 黄永明[1] 徐伟龙[1] 肖大为[1] 黄国钦[1] 

机构地区：[1]广东省中医院骨科,中国广州510006

出　　处：《中国矫形外科杂志》2014年第20期1825-1830,共6页Orthopedic Journal of China

摘　　要：[目的]克氏针张力带联合铆钉喙锁韧带重建治疗NeerⅡ锁骨远端骨折的临床与影像学评估。[方法]自2008-2012年,本院共有17例NeerⅡ锁骨远端骨折患者行克氏针张力带联合铆钉喙锁韧带重建治疗,通过Constant、DASH评分、骨折愈合时间及喙锁间距对其临床及影像学结果进行评估。[结果]平均随访24.2个月（12-49个月）,其中16例患者骨折获得愈合,愈合时间平均3.8个月,1例在术后1周克氏针松脱,后行锁骨远端切除术。15例患者在末次随访时维持解剖复位,但有1例患者患侧喙锁间距较健侧增加40.3%,1例患者锁骨上不可吸收缝线周围的骨道在末次17个月随访时仍较明显并有所增大,1例患者出现迟发性感染但得到了良好的控制,但这些患者患肩均恢复到了术前的活动水平,且在随访过程中没有出现影响患者日常活动的症状。末次随访时Constant和DASH评分分别为97.7分（72-100分）和1.9分（0-26.5分）。[结论]克氏针张力带联合铆钉喙锁韧带重建是NeerⅡ锁骨远端骨折治疗的一种良好的初始选择,其不仅可以获得良好的关节功能,而且并发症较少。[Objective]The purpose of this study is to evaluate the clinical and radiological results of Neer type Ⅱ distal clavicle fractures treated by tension band wiring combined with an additional suture anchor augmenting the coracoclavicular ligament.[Method]A total of seventeen Neer type Ⅱ distal clavicle fractures,managed with this kind of operative approach at our institution between 2008 to 2012,were included. The Constant and DASH scores were used to assess the clinical outcome at latest follow- up time. Meanwhile,radiological union and coracoclavicular distances were evaluated by standard views including an antero- posterior view and an axillary view.[Result]All patients had an average follow- up period of 24. 2 months（ range 12- 49 months）. Fracture union was achieved in 16 patients at a mean 3. 8 months postoperatively. One patient suffered a loosening of Kirshner wires at 1st week postoperatively,and subsequently,distal clavicle resection was performed. Anatomical reduction maintained in 15 patients at last follow- up time. However,coracoclavicular distance of the injured shoulder increased by40. 3% compared with that of the contralateral side in one patient. The holes in clavicle around non- absorbable suture had obviously enlarged in one patient and it was still noticeable at final follow up of 17 months. Delayed superficial infection was found in one patient and got successful control. However,all these patients returned to pre-injury performance level and neither of these patients had any clinical symptoms that affected their daily activities throughout follow- up. The Constant and DASH scores were 97. 7（ range 72- 100） and 1. 9（ 0- 26. 5） at final visit,respectively. [Conclusion]Tension band wiring combined with an additional suture anchor augmenting the coracoclavicular ligament is a good primary treatment option for Neer typeⅡ lateral clavicle fracture with excellent shoulder function and few complications.

关 键 词：锁骨远端骨折 NeerⅡ 克氏针张力带 铆钉 喙锁韧带 

分 类 号：R687.3[医药卫生—骨科学]