应用锁骨钩钢板治疗NeerⅡ型锁骨远端骨折后并发锁骨中段骨折的回顾研究  

Midshaft clavicle fracture following osteosynthesis with a hook plate for the treatment of Neer typeⅡdistal clavicle fractures:a retrospective study

作　　者：李一汉[1] 田庆显[1] 郭蒙 冷昆鹏 LI Yi-han;TIAN Qing-xian;GUO Meng;LENG Kun-peng(Department of Orthopedics,Beijing Chaoyang Hospital,Capital Medical University,Beijing,100024,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100024

出　　处：《中国骨与关节杂志》2024年第12期990-995,共6页Chinese Journal of Bone and Joint

摘　　要：目的探究应用锁骨钩钢板治疗NeerⅡ型锁骨远端骨折后并发锁骨中段骨折的危险因素以及避免出现这一并发症的手术技巧。方法回顾分析2010年2月至2022年1月,于我院诊断为NeerⅡ型锁骨远端骨折并接受锁骨钩钢板内固定治疗的385例患者。根据是否出现钩钢板治疗术后锁骨中段骨折,分为并发症组(1组,17例)和对照组(2组,368例)。收集了患者一般资料,钩钢板最内侧螺钉的类型,钩钢板是否在术中得到了塑形,钩钢板的长度及深度。组间比较采用χ2检验,后采用多因素Logistic回归分析钩钢板固定锁骨远端骨折术后并发锁骨中段骨折的独立危险因素。结果与2组相比,1组内老年患者占比显著更高(12.5%vs.41.2%,P=0.001),且术中使用未塑形钩钢板的患者也显著更高(44.0%vs.82.4%,P=0.004),差异均有统计学意义。多因素Logistic回归分析结果提示,老年患者更可能出现这一并发症(未调节OR值为4.900,P=0.002;调节OR值为4.041,P=0.008),术中使用未塑形钩钢板的患者也更可能出现这一并发症(未调节OR值为5.934,P=0.006;调节OR值为5.176,P=0.012)。结论应用锁骨钩钢板来治疗锁骨远端骨折时,术后有一定概率出现锁骨中段骨折,老年和术中钩钢板未进行塑形是出现这一并发症的独立危险因素,改进手术技术可能会降低该并发症的发生率。Objective To discover the risk factors for the midshaft clavicle fracture at the medial end of the hook plate following internal fixation for Neer typeⅡdistal clavicle fractures and to suggest preventive surgical techniques.Methods Between February 2010 and January 2022,a total of 385 patients were diagnosed with Neer typeⅡdistal clavicular fractures and treated with hook plates at our trauma center.All patients were divided into either the complication group(groupⅠ,patients with midshaft fractures,n=17)or the control group(groupⅡ,patients without midshaft fractures,n=368).Data collected included patient demographics,type of medial screw,plate or hook bending during the surgery,the number of holes in the plate,and hook plate depth.The Chi-square test was used to conduct between-group comparisons of these variables.Statistically significant variables were included in a multivariate logistic regression analysis to identify independent risk factors for midshaft clavicle fractures following hook plate fixation for distal clavicle fractures.Results Compared to the control group,there were significantly more elderly patients(12.5%vs.41.2%,P=0.001)and significantly more patients treated with hook plates that were not bent during surgery(44.0%vs.82.4%,P=0.004)in the complication group.The differences were statistically significant.Based on the multivariate logistic regression analysis,elderly patients were more likely to experience clavicular midshaft fractures(unadjusted OR,4.900;P=0.002;adjusted OR,4.041;P=0.008).Patients treated with hook plates that were not bent during surgery were more likely to experience midshaft fractures(unadjusted OR,5.934;P=0.006;adjusted OR,5.176;P=0.012).Conclusions The incidence of midshaft clavicle fractures following osteosynthesis with a clavicle hook plate for the treatment of distal clavicle fractures is not negligible,especially in elderly patients and patients treated with hook plates that are not bent during surgery.Therefore,the two variables are independent risk factors f

关 键 词：锁骨 骨折 手术后并发症 骨板 

分 类 号：R683.4[医药卫生—骨科学]