克氏针联合袢钢板与解剖锁定钢板联合韧带悬吊治疗Neer IIb型锁骨远端骨折的疗效差异

doi:10.13418/j.issn.1001-165x.2021.06.016

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中国临床解剖学杂志 ›› 2021, Vol. 39 ›› Issue (6) : 711-715. DOI: 10.13418/j.issn.1001-165x.2021.06.016

临床研究

克氏针联合袢钢板与解剖锁定钢板联合韧带悬吊治疗Neer IIb型锁骨远端骨折的疗效差异

李玉，　马建文，　黄永

作者信息 +

Clinical effect of Kirschner wire loop plate and anatomical locking plate combined with ligaments suspended for the treatment of Neer IIb distal clavicle fracture

Li Yu, Ma Jianwen, Huang Yong

Author information +

文章历史 +

摘要

目的　比较克氏针联合袢钢板与解剖锁定钢板联合喙锁韧带悬吊技术治疗Neer IIb型锁骨远端骨折的疗效。方法　将46例接受治疗的Neer IIb型锁骨远端骨折患者按照不同固定方式分为观察组（克氏针联合袢钢板，22例）和对照组（解剖锁定钢板联合喙锁韧带悬吊技术，24例），评估手术时间、透视次数、术中失血量、切口长度、骨折愈合时间、住院时间、VAS疼痛评分及肩关节Constant功能评分等指标。结果　观察组术中失血量、切口长度及骨折愈合时间均低于对照组（P<0.05）。观察组手术时间及透视次数均高于对照组（P<0.05）。住院时间方面，两组患者比较未见明显差异（P>0.05）。观察组喙锁间隙距离小于对照组（P<0.05）。两组患者术后即刻VAS评分及Constant功能评分无统计学差异（P>0.05）；术后3个月随访，观察组VAS评分及肩关节Constant功能评分均优于对照组（P<0.05）。结论　克氏针联合袢钢板治疗Neer IIb型锁骨远端骨折安全有效，能够有效提高患者生活质量，值得临床推广。

Abstract

Objective 　To compare the difference of clinical effect between Kirschner wire loop plate and anatomical locking plate combined with ligaments suspended for the treatment of Neer IIb distal clavicle fracture.　Methods　According to different fixation methods, 46 patients with Neer IIb distal clavicle fracture who received treatment were divided into an observation group (22 patients with Kirschner wire loop plate) and a control group (24 patients with anatomical locking plate combined with ligaments suspended). Operation time, fluoroscopy frequency, intraoperative blood loss, incision length, fracture healing time, hospital stay, VAS pain score and Constant function score of shoulder joint and other indicators were evaluated.　Results　Intraoperative blood loss, incision length and fracture healing time in the observation group were significantly lower than those in the control group (P<0.05). While the operation time and fluoroscopy times in the observation group were significantly higher than those in the control group (P<0.05). There was no significant difference in the hospital stay between the two groups (P>0.05). The gap distance of beak lock in the observation group was lower than that in the control group (P<0.05). There were no statistical difference in the immediate VAS score and Constant function score between the two groups (P>0.05). At 3 months follow-up, the VAS score and the Constant function score of shoulder joint in the observation group were better than control group (P<0.05).　Conclusions　Kirschner wire loop plate for the treatment of Neer IIb distal clavicle fracture is safe and effective, and can effectively improve the quality of life of patients, which is worthy of extensive clinical promotion.

导出引用

李玉, 　马建文, 　黄永. 克氏针联合袢钢板与解剖锁定钢板联合韧带悬吊治疗Neer IIb型锁骨远端骨折的疗效差异[J]. 中国临床解剖学杂志. 2021, 39(6): 711-715 https://doi.org/10.13418/j.issn.1001-165x.2021.06.016

Li Yu, Ma Jianwen, Huang Yong. Clinical effect of Kirschner wire loop plate and anatomical locking plate combined with ligaments suspended for the treatment of Neer IIb distal clavicle fracture[J]. Chinese Journal of Clinical Anatomy. 2021, 39(6): 711-715 https://doi.org/10.13418/j.issn.1001-165x.2021.06.016

中图分类号： R683.41

参考文献

[1] 胡喜春, 黄长明, 范华强, 等. 钢板线缆与钩钢板治疗Neer Ⅱ型锁骨远端骨折的对比[J]. 中国矫形外科杂志, 2019, 27(22): 2046-2049. DOI: 10.3977/j.issn.1005-8478.2019.22.07.
[2] 林三福, 姚学东, 戴章生, 等. 解剖锁定钢板结合锚钉与锁骨钩钢板治疗Neer Ⅱb型锁骨远端骨折的疗效比较[J]. 中华创伤骨科杂志, 2017, 19(1): 41-46. DOI: 10.3760/cma.j.issn.1671-7600.2017.01.007.
[3] Vaishya R, Vijay V, Khanna V. Outcome of distal end clavicle fractures treated with locking plates[J]. Chin J Traumatol, 2017, 20(1): 45-48. DOI: 10.1016/j.cjtee.2016.05.003.
[4] Zhang XJ, Cheng XD, Yin B, et al. Finite element analysis of spiral plate and Herbert screw fixation for treatment of midshaft clavicle fractures[J]. Medicine, 2019, 98(34): e16898. DOI: 10.1097/MD.0000000000016898.
[5] Zheng YR, Lu YC, Liu CT. Treatment of unstable distal-third clavicule fractures using minimal invasive closed-loop double endobutton technique[J]. J Orthop Surg Res, 2019, 14(1): 37. DOI: 10.1186/s13018-019-1073-5.
[6] Şükür E, öztürkmen Y, Akman YE, et al. Clinical and radiological results on the fixation of Neer type 2 distal clavicle fractures with a hook plate[J]. Acta Orthop Traumatol Turc, 2016, 50(5): 489-493. DOI: 10.1016/j.aott.2016.08.012.
[7] Asadollahi S, Bucknill A. Acute medial clavicle fracture in adults: a systematic review of demographics, clinical features and treatment outcomes in 220 patients[J]. J Orthop Traumatol, 2019, 20(1): 24. DOI: 10.1186/s10195-019-0533-3.
[8] Liu QJ, Miao JY, Lin B, et al. Surgical treatment for unstable distal clavicle fracture with micromovable and anatomical acromioclavicular plate[J]. Int J Med Sci, 2012, 9(4): 301-305. DOI: 10.7150/ijms.4425.
[9] Yagnik GP, Jordan CJ, Narvel RR, et al. Distal clavicle fracture repair: clinical outcomes of a surgical technique utilizing a combination of cortical button fixation and coracoclavicular ligament reconstruction[J]. Orthop J Sports Med, 2019, 7(9): 2325967119867920. DOI: 10.1177/2325967119867920.
[10] Struhl S, Wolfson TS. Closed-loop double endobutton technique for repair of unstable distal clavicle fractures[J]. Orthop J Sports Med, 2016, 4(7): 2325967116657810. DOI: 10.1177/2325967116657810.
[11] Dan J, Kim BK, Lee HJ, et al. Supplementary technique for unstable clavicle shaft fractures: interfragmentary wiring and temporary axial K-wire pinning[J]. Clin Orthop Surg, 2018, 10(2): 142-148. DOI: 10.4055/cios.2018.10.2.142.
[12] 李品, 吕建军, 程文丹, 等. 双带襻钢板与锁骨钩钢板治疗锁骨远端骨折的比较[J]. 实用骨科杂志, 2015, (3): 264-267. DOI: 10.7666/d.D707877.