锁骨远端骨折新分型的建立及临床应用效果评价  

Establishment of a new classification system for distal clavicle fracture and its clinical efficiency evaluation

作　　者：薛骋 郑兴国 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] Xue Cheng;Zheng Xingguo;Li Xiang;Song Lijun;Qin Xiaodong;Lyu Tianrun;Chen Qun;Xue Kaixiao;Fang Jiahu(Department of Orthopedics,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Orthopedics,Affiliated Hospital of 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：《中华创伤杂志》2024年第6期539-546,共8页Chinese Journal of Trauma

基　　金：江苏省卫健委重点课题(ZD2021001)。

摘　　要：目的建立锁骨远端骨折新分型并评估其临床应用效果。方法采用回顾性病例系列研究分析南京医科大学第一附属医院2015年1月至2022年3月收治的101例锁骨远端骨折患者的临床资料,其中男57例,女44例;年龄19~86岁[(53.8±14.0)岁]。治疗前,常规摄双侧肩关节正位X线片,测量骨折块长度、喙锁间距和肩锁间距。根据骨折线位置和喙锁韧带止点关系将锁骨远端骨折分为三型:Ⅰ型为骨折线位于喙锁韧带区域外侧,Ⅱ型为骨折线位于喙锁韧带区域,Ⅲ型为骨折线位于喙锁韧带区域内侧。根据喙锁韧带和肩锁韧带损伤情况将Ⅰ型进一步细分为ⅠA、ⅠB、ⅠC和ⅠD型;Ⅱ型进一步细分为ⅡA、ⅡB、ⅡC、ⅡD和ⅡE型。由10名高年资和10名低年资肩关节外科医师依据新分型方法对101例患者进行分型,间隔3个月后随机再次分型。采用Kappa系数评价新分型观察者间和观察者内的一致性。52例稳定骨折(ⅠA、ⅠB、ⅡC、ⅡD型)采取非手术治疗;49例不稳定骨折(ⅠC、ⅠD、ⅡA、ⅡB、ⅡE、Ⅲ型)采取手术治疗,其中喙锁韧带解剖重建26例,锁定钢板固定9例,锁骨钩钢板固定8例,锁定钢板固定联合喙锁韧带解剖重建4例,拉力螺钉固定联合喙锁韧带解剖重建2例。记录治疗前及治疗后3、6、12、18个月视觉模拟评分(VAS)及Constant-Murley肩关节评分;在治疗后3、6、12、18个月健侧和患侧肩关节正位X线片上测量喙锁间距和肩锁间距;观察骨折愈合时间及并发症发生情况。结果骨折块长度Ⅰ型骨折患者为12.9(9.7,17.6)mm,Ⅱ型骨折患者为24.7(21.8,27.8)mm,Ⅲ型骨折患者为43.6(41.2,46.9)mm(P<0.01)。ⅠA、ⅠB、ⅡC、ⅡD和Ⅲ型骨折患者患侧喙锁间距和肩锁间距较健侧差异均无统计学意义(P>0.05);ⅠC、ⅡA、ⅡB和ⅡE型骨折患者患侧喙锁间距较健侧均明显增大(P<0.01),而患侧肩锁间距较健侧差异均无统计学意义(P>0.05)。新分型的观Objective To establish a new classification system for distal clavicle fracture and evaluate its clinical effectiveness.Methods A retrospective case series study was conducted to analyze the clinical data of 101 patients with distal clavicle fracture admitted to First Affiliated Hospital of Nanjing Medical University from January 2015 to March 2022,including 57 males and 44 females,aged 19-86 years[(53.8±14.0)years].Before treatment,patients were routinely subjected to bilateral anteroposterior radiography of the shoulder joints to measure the length of the fractured fragments,coracoclavicular distance,and acromioclavicular distance.According to the correlation between the location of the fracture line and the insertion of the coracoclavicular ligament,distal clavicle fracture was divided into three types:type I,with the fracture line lateral to the coracoclavicular ligament region;type II,with the fracture line in the coracoclavicular ligament region;type III,with the fracture line medial to the coracoclavicular ligament region.According to the injury severity of the coracoclavicular ligament and acromioclavicular ligament,type I was further subdivided into type IA,IB,IC and ID,and type II fracture was further subdivided into type IIA,IIB,IIC,IID and IIE.All the 101 patients were classified and randomly reclassified at an interval of 3 months by 10 senior and 10 junior shoulder surgeons according to the new classification method.Kappa coefficients were used to evaluate the inter-and intra-observer consistency of the new classification.Fifty-two patients with stable fracture(types IA,IB,IIC,and IID)were treated non-surgically,while 49 patients with unstable fracture(types IC,ID,IIA,IIB,IIE,and III)were treated surgically,including 26 patients with anatomic coracoclavicular ligament reconstruction,9 with locking plate fixation,8 with clavicle hook plate fixation,4 with anatomic coracoclavicular ligament reconstruction combined with locking plate fixation,and 2 with anatomic coracoclavicular ligament reconstructio

关 键 词：锁骨 骨折 韧带 肩锁关节 分类法 

分 类 号：R687.3[医药卫生—骨科学]