两种术式固定锁骨远端Neer Ⅱb型骨折比较  

Comparison of two surgical methods for treatment of Neer type Ⅱb distal clavicular fractures

作　　者：俞云飞[1] 胡钢[1] 严松鹤[1] 吴毛[1] YU Yun-fei;HU Gang;YAN Song-he;WU Mao(Wuxi Hospital of Traditional Chinese Medicine,Wuxi 214000,China)

机构地区：[1]无锡市中医医院,江苏无锡214000

出　　处：《中国矫形外科杂志》2023年第20期1836-1841,共6页Orthopedic Journal of China

基　　金：无锡市“双百”后备拔尖人才项目(编号:HB2020064)。

摘　　要：[目的]比较Tight-rope技术联合Nice结加强固定与解剖锁定钢板技术治疗锁骨远端NeerⅡb型骨折的临床疗效。[方法]回顾性分析2017年1月-2020年12月在本科接受手术治疗的锁骨远端NeerⅡb型骨折58例患者的临床资料。根据医患沟通结果,27例采用Tight-rope技术联合Nice结治疗(袢板组),31例采用锁骨远端解剖锁定钢板固定(钢板组)。比较两组围手术期、随访和影像资料。[结果]袢板组手术时间[(71.4±31.8)min vs(85.2±27.0)min,P<0.05]、切口总长度[(3.6±1.3)cm vs(10.1±2.0)cm,P<0.05]、术中出血量[(24.4±19.4)ml vs(96.7±43.3)ml,P<0.05]、住院时间[(10.8±3.7)d vs(13.4±5.5)d,P<0.05]、主动活动时间[(28.5±4.2)d vs(34.5±3.9)d,P<0.05]均显著优于钢板组。两组患者均获得超过24个月随访。袢板组恢复完全负重活动时间显著早于钢板组[(19.0±1.5)周vs(21.3±2.5)周,P<0.05]。随时间推移,两组患者Constant-Murley评分、肩关节的外展上举、前屈上举及内外旋活动度均显著增加(P<0.05)。术前两组间上述指标的差异均无统计学意义(P>0.05),术后3个月袢板组在Constant-Murley评分[(80.7±4.4)vs(78.3±4.5),P<0.05]、外展上举ROM[(121.9±9.0)°vs(112.7±8.4)°,P<0.05]、前屈上举ROM[(128.5±6.8)°vs(119.4±8.0)°,P<0.05]和内外旋ROM[(115.9±5.5)°vs(112.1±5.7)°,P<0.05]均显著优于钢板组。影像方面,袢板组术后骨折复位质量显著优于钢板组[优/良/差,(21/7/0)vs(1/17/2),P<0.05]。两组患者术后喙锁距离(coracoclavicular distance,CCD)均显著减小(P<0.05),末次随访时袢板组CCD显著小于钢板组[(9.4±1.8)mm vs(11.9±1.4)mm,P<0.05]。两组患者骨折愈合时间的差异无统计学意义(P>0.05)。[结论]两种手术方式治疗锁骨远端NeerⅡb型骨折均获得良好临床疗效,而使用Tight-rope技术联合Nice结加强固定手术创伤更小,可以更好地改善术后早期疼痛及肩关节功能。[Objective]To compare the clinical efficacy of Tight-rope combined with Nice knot reinforcement versus anatomical lock-ing plate in the treatment of Neer type IIb distal clavicular fractures.[Methods]A retrospective study was performed on 58 patients who re-ceived surgical treatment for Neer type IIb distal clavicular fractures in our department from January 2017 to December 2020.According to the results of doctor-patient communication,27 patients underwent Tight-rope combined with Nice knot(TR group),while the other 31 patients received anatomic locking plate for fixation of the distal clavicular fracture(plate group).The perioperative,follow-up and imaging data were compared between the two groups.[Results]The TR group proved significantly superior to the plate group in terms of operation time[(71.4±31.8)min vs(85.2±27.0)min,P<0.05],the total length of incision[(3.6±1.3)cm vs(10.1±2.0)cm,P<0.05],intraoperative bleeding[(24.4±19.4)ml vs(96.7±43.3)ml,P<0.05],hospital stay[(10.8±3.7)days vs(13.4±5.5)days,P<0.05]and time to return active ac-tivity[(28.5±4.2)days vs(34.5±3.9)days,P<0.05].All of them in both groups were followed up for more than 24 months,and TR group re-sumed full weight-bearing activity significantly earlier than the plate group[(19.0±1.5)weeks vs(21.3±2.5)weeks,P<0.05].The ConstantMurley scores,abduction-lifting,forward flexion upward lifting,and internal-external rotation range of motion(ROM)of the shoulder in-creased significantly over time in both groups(P<0.05).Although there was no significant difference in the above items between the two groups before surgery(P>0.05),the TR group proved significantly superior to the plate group in terms of Constant-Murley score[(80.7±4.4)vs(78.3±4.5),P<0.05],abduction-lifting ROM[(121.9±9.0)°vs(112.7±8.4)°,P<0.05],forward flexion upward lifting ROM[(128.5±6.8)°vs(119.4±8.0)°,P<0.05]and the internal-external rotation ROM[(115.9±5.5)°vs(112.1±5.7)°,P<0.05]3 months postoperatively.Radio-graphically,the TR group was significantly better

关 键 词：锁骨远端骨折 肩锁关节脱位 Tight-rope Nice结 解剖锁定钢板 

分 类 号：R683.41[医药卫生—骨科学]