带线锚钉重建喙锁韧带在解剖锁定钢板内固定治疗锁骨远端NeerⅡB型骨折中的应用  

Application of coracoclavicular ligament reconstruction using suture anchors in surgery of anatomic locking plate internal fixation for treatment of Neer typeⅡB distal clavicle fractures

作　　者：张传开 郝亮 陈强 蒋守海 邱东新 ZHANG Chuankai;HAO Liang;CHEN Qiang;JIANG Shouhai;QIU Dongxin(Xuzhou Renci Hospital,Xuzhou 221000,Jiangsu,China)

机构地区：[1]徐州仁慈医院,江苏徐州221000

出　　处：《中医正骨》2022年第11期7-13,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:探讨带线锚钉重建喙锁韧带在解剖锁定钢板内固定治疗锁骨远端NeerⅡB型骨折中的应用价值。方法:回顾性分析2018年1月至2021年1月收治的146例锁骨远端NeerⅡB型骨折患者的病例资料,其中新鲜骨折100例、陈旧性骨折46例,新鲜骨折中54例采用解剖锁定钢板内固定治疗(新鲜单纯组)、46例采用解剖锁定钢板内固定联合带线锚钉重建喙锁韧带治疗(新鲜联合组),陈旧性骨折中26例采用解剖锁定钢板内固定治疗(陈旧单纯组)、20例采用解剖锁定钢板内固定联合带线锚钉重建喙锁韧带治疗(陈旧联合组)。比较新鲜骨折、陈旧性骨折中2组患者的骨折愈合时间、Constant-Murley肩关节功能评分、喙锁间隙增加率、肩部疼痛视觉模拟量表(visual analogue scale,VAS)评分。结果:所有患者均获随访,随访时间6~13个月,中位数9.5个月。2组新鲜骨折患者的骨折愈合时间及末次随访时的肩部疼痛VAS评分、喙锁间隙增加率、Constant-Murley肩关节功能评分比较,组间差异均无统计学意义[(13.28±1.36)周,(12.89±2.73)周,t=0.924,P=0.358;(4.07±1.67)分,(4.32±2.11)分,t=-0.661,P=0.510;(14.21±7.89)%,(12.84±6.33)%,t=0.946,P=0.346;(90.94±5.73)分,(91.89±4.82)分,t=-0.888,P=0.377];末次随访时2组患者的Constant-Murley肩关节功能评分均较术前增加(t=-39.252,P=0.001;t=-43.710,P=0.001)。2组陈旧性骨折患者末次随访时的肩部疼痛VAS评分比较,差异无统计学意义[(3.37±1.11)分,(3.84±1.18)分,t=-1.385,P=0.173];陈旧单纯组的骨折愈合时间长于陈旧联合组,末次随访时的喙锁间隙增加率高于陈旧联合组[(19.47±6.34)周,(12.81±3.28)周,t=4.271,P=0.001;(21.59±13.15)%,(12.17±6.38)%,t=2.943,P=0.005],末次随访时的Constant-Murley肩关节功能评分低于陈旧联合组[(83.45±5.28)分,(93.57±6.04)分,t=-6.053,P=0.001];末次随访时2组患者的Constant-Murley肩关节功能评分均较术前增加(t=-22.115,P=0.001;t=-23.738,P=0.001)。Objective:To assess the application value of coracoclavicular ligament reconstruction using suture anchors in surgery of anatomic locking plate internal fixation for treatment of Neer typeⅡB distal clavicle fractures.Methods:The medical data of 146 patients with Neer typeⅡB distal clavicle fractures admitted from January 2018 to January 2021 were retrospectively analyzed, including 100 fresh fractures and 46 old fractures.Among the patients with fresh fractures, 54 cases were treated with anatomical locking plate internal fixation(fresh-blank group)and 46 cases were treated with anatomical locking plate internal fixation combined with coracoclavicular ligament reconstruction using suture anchors(fresh-combination group).Among the patients with old fractures, 26 cases were treated with anatomical locking plate internal fixation(old-blank group)and 20 cases were treated with anatomical locking plate internal fixation combined with coracoclavicular ligament reconstruction using suture anchors(old-combination group).The fracture healing time, Constant-Murley score(CMS),increase rate of coracoclavicular space, and visual analogue scale(VAS)score of shoulder pain were compared between fresh-blank group and fresh-combination group and between old-blank group and old-combination group respectively.Results:All patients were followed up for 6-13 months with a median of 9.5 months.There was no significant difference in healing time, VAS score of shoulder pain,increase rate of coracoclavicular space,and CMS at the last follow-up between the two fresh fracture groups(13.28±1.36 vs12.89±2.73 weeks,t= 0.924,P=0.358;4.07±1.67 vs 4.32±2.11 points,t=-0.661,P=0.510;14.21±7.89 vs 12.84±6.33%,t=0.946,P=0.346;90.94±5.73 vs 91.89±4.82 points,t=-0.888,P=0.377).Compared to pre-surgery,the CMS of the two groups increased at the last follow-up(t=-39.252,P=0.001;t=-43.710,P= 0.001).There was no significant difference in the VAS score of shoulder pain between the two old fracture groups at the last follow-up(3.37±1.11 vs 3.84±1

关 键 词：锁骨 肩骨折 骨折固定术 内 骨板 缝合锚 喙锁韧带 

分 类 号：R687.3[医药卫生—骨科学]