TightRope钢板与锁骨钩钢板治疗NeerⅡ型锁骨远端骨折疗效比较  

Comparison of TightRope plate and clavicular hook plate in treatment of Neer type Ⅱ fractures of distal clavicle

作　　者：赵晨[1] 胡劲涛 邱斌松[1] 顾海峰[1] 章水均[1] 徐跻峰[1] 姚斌[1] 陈垍航 夏冰[1] 毕擎[1] 

机构地区：[1]浙江省人民医院骨科,杭州310014 [2]绍兴市柯桥区中医医院骨科

出　　处：《浙江医学》2015年第7期544-548,共5页Zhejiang Medical Journal

摘　　要：目的分析TightRope(TR)钢板与锁骨钩钢板治疗NeerⅡ型锁骨远端骨折的临床疗效。方法回顾性分析2010年2月至2013年1月手术治疗的55例NeerⅡ型锁骨远端骨折患者。24例患者选择TR钢板治疗,其中男18例,女6例,平均年龄36.6岁;31例患者选择锁骨钩钢板治疗,其中男24例,女7例,平均年龄36.7岁。观察术后并发症发生情况,术后第5天疼痛,术后6个月(未拆除钢板)及术后1年疼痛、肩关节功能及生活质量,末次随访时的喙锁间隙及愈合后骨折移位情况。结果在术后第5天的VAS疼痛评分中,锁骨钩钢板组大于TR组;术后6个月锁骨钩钢板组的Constant评分及SF-36低于TR组(Constant评分:86.3比90.5;SF-36:81.7比92.4,P<0.05),VAS疼痛评分前者高于后者(2.1比0.3,P<0.05),术后6个月随访中锁骨钩钢板未拆除时锁骨钩钢板组有5例患者出现肩峰撞击症,在钢板拆除后症状消失。在术后1年的随访中,锁骨钩钢板组Constant评分较术后6个月有改善,但仍低于TR组(90.7比93.1,P<0.05),SF-36评分TR组优于锁骨钩钢板组(87.5比93.3,P<0.05),两组患者疼痛评分差异无统计学意义(P>0.05),锁骨钩钢板组在钢板拆除后出现2例肩袖损伤,2例均行保守治疗后得到改善。两组患者末次随访喙锁间隙及骨折端移位情况差异均无统计学意义(均P>0.05)。结论在治疗卜NeerⅡ型锁骨骨折上两种钢板的治疗均能获得良好的复位效果,TR钢板具有术后疼痛轻、并发症少及肩关节功能恢复更好的优势,是NeerⅡ型锁骨骨折的有效治疗方法。Objective To compare the clinical effect of TightRope plate and clavicular hook plate in treatment of Neer type II fractures of distal clavicle. Methods Fifty five patients with Neer II type distal clavicle fracture underwent surgical treatment in our hospital from February 2010 to January 2013, including 24 cases receiving TightRope surgery and 3 cases received clavicular hook plate surgery. The postoperative complications, pain in 5d, 6 months and 1 year after operation, joint function and quality of life, coracoclavicular space and fracture shift distance at the last follow-up were evaluated and compared between two groups. Results The average VAS pain score 5 d after operative in clavicular hook plate group was higher than that in TightRope group. The score of Constant and SF-36 scores of clavicular hook plate group was lower than that of TightRope group 6 months after operation （Constant score： 86.3 vs 90.5; SF-36：81.7 vs 92.4, P〈0.05）, VAS pain scores in the former was higher than that in the latter （2.1 vs 0.3, P〈0.05）. Five patients in clavicular hook plate group presented acromion impingement syndrome during 6 month follow-up time （clavicular hook plate was not removed）, which disappeared after plate removed. In 1 years postoperative follow-up, Constant scores in clavicular hook plate group was improved, compared to those in 6 months after surgery, but still lower than that in TightRope group （90.7 vs 93.1, P〈0.05）. SF-36 score in TightRope group was better than that in clavicular hook plate group （93.3 vs 87.5,P〈0.05）, there was no significant difference in pain scores between two groups （P 〉0.05）. Two patients in clavicular hook plate group presented rotator cuff injury after plate removal, which was recovered by conservative treatment. There was no statistically significant difference in coracoclavicular space and displacement of fracture at the time of the latest follow-up between two groups （P 〉0.05）. Conclusion Both TightRope plate and clavicular hook pla

关 键 词：TIGHTROPE 锁骨骨折 NEER Ⅱ型 

分 类 号：R687.3[医药卫生—骨科学]