喙锁韧带解剖重建与钩钢板治疗锁骨远端Neer Ⅱb型骨折的疗效比较  

Comparison of coracoclavicular ligament anatomical reconstruction versus clavicular hook plate in treatment of NeerⅡb distal clavicular fractures

作　　者：郑兴国 薛骋 李翔[1] 宋李军[1] 秦晓东[1] 吕天润[1] 陈群[1] 薛铠啸 方加虎[1] Zheng Xingguo;Xue Cheng;Li Xiang;Song Lijun;Qin Xiaodong;Lyu Tianrun;Chen Qun;Xue Kaixiao;Fang Jiahu(Department of Orthopaedics,The First Affiliated Hospital to Nanjing Medical University,Nanjing 210029,China;Department of Orthopedics,Hospital Affiliated to Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]南京医科大学第一附属医院骨科,南京210029 [2]徐州医科大学附属医院骨科,徐州221000

出　　处：《中华创伤骨科杂志》2022年第5期421-428,共8页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较喙锁韧带解剖重建与锁骨钩钢板治疗锁骨远端Neer Ⅱb型骨折的疗效。方法回顾性分析2016年9月至2019年6月在南京医科大学第一附属医院骨科接受手术治疗的64例锁骨远端Neer Ⅱb型骨折患者资料, 男35例, 女29例;年龄19~68岁, 平均50.7岁。所有患者根据手术方式不同分为2组:重建组30例(采用喙锁韧带解剖重建技术治疗), 钩钢板组34例(采用锁骨钩钢板治疗)。比较两组患者住院时间、手术时间、术中出血量、手术切口长度、术后喙锁间距分离比、术后3、6、12个月疼痛视觉模拟评分(VAS)和肩关节功能Constant-Murley评分及并发症情况。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05), 具有可比性。两组患者均成功完成手术, 术后切口均一期愈合。所有患者术后获12~24个月(平均14.6个月)随访。钩钢板组患者手术时间[(74.6±22.0) min]和切口长度[(10.4±0.4) cm]均短于重建组[(95.6±20.8) min、(12.4±0.9) cm], 但术中出血量[(90.2±5.3)mL]较重建组[(74.2±3.5)mL]多, 以上项目两组间比较差异均有统计学意义(P<0.05)。两组间住院时间比较差异无统计学意义(P>0.05)。术后3、6、12个月重建组的VAS评分[(1.8±0.5)、(1.2±0.3)、(1.1±0.2)分]、Constant-Murley评分[(85.2±4.6)、(91.1±2.6)、(92.1±2.2)分]均优于钩钢板组[(3.2±1.0)、(1.6±0.3)、(1.5±0.3)、(73.6±2.9)、(85.9±4.6)、(87.0±3.1)分], 差异均有统计学意义(P<0.05)。末次随访时, 钩钢板组患者术后喙锁间距分离比(抬高)(0.20±0.16)大于重建组(0.10±0.05), 差异有统计学意义(P<0.05)。随访期间重建组未发生并发症;而钩钢板组7例患者发生术后肩关节疼痛。结论与钩钢板固定相比, 喙锁韧带解剖重建技术治疗锁骨远端Neer Ⅱb型骨折的固定效果更好, 同时避免了应用钩钢板所带来的并发症, 具有良好的临床疗效。Objective To compare the clinical efficacy between coracoclavicular ligament anatomical reconstruction and clavicular hook plate in the treatment of NeerⅡb distal clavicular fractures.Methods A total of 64 patients with NeerⅡb clavicular fracture were treated at Department of Orthopaedics,The First Affiliated Hospital to Nanjing Medical University from September 2016 to June 2019.They were 35 males and 29 females,aged from 19 to 68 years(average,50.7 years).They were assigned into 2 groups according to their operative methods:a reconstruction group of 30 cases undergoing coracoclavicular ligament anatomical reconstruction and a hook plate group of 34 cases undergoing fixation with a clavicular hook plate.The 2 groups were compared in terms of hospital stay,operation time,intraoperative blood loss,surgical incision length,postoperative coracoclavicular separation ratio,visual analogue scale(VAS)and Constant-Murley shoulder scores at 3,6 and 12 months after operation,and postoperative complications.Results There was no significant difference in general data between the 2 groups,showing comparability between groups(P>0.05).Operations were completed uneventfully and surgical incisions healed by primary intention in both groups after operation.All the patients were followed up for 12 to 24 months(average,14.6 months).The operation time[(74.6±22.0)min]and incision length[(10.4±0.4)cm]were significantly shorter but the intraoperative blood loss[(90.2±5.3)mL]was significantly less in the hook plate group than those in the reconstruction group[(95.6±20.8)min,(12.4±0.9)cm and(74.2±3.5)mL](P<0.05).There was no significant difference in hospital stay between the 2 groups(P>0.05).At 3,6 and 12 months after operation,the VAS scores(1.8±0.5,1.2±0.3 and 1.1±0.2)and Constant-Murley scores(85.2±4.6,91.1±2.6 and 92.1±2.2)in the reconstruction group were significantly better than those in the hook plate group(3.2±1.0,1.6±0.3 and 1.5±0.3;73.6±2.9,85.9±4.6 and 87.0±3.1)(P<0.05).At the last follow-up,the postopera

关 键 词：锁骨 骨折 韧带 解剖 肩锁关节 

分 类 号：R687.3[医药卫生—骨科学]