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[1]張傳開,郝亮,陳強,等.帶線錨釘重建喙鎖韌帶在解剖鎖定鋼板內(nèi)固定治療鎖骨遠端NeerⅡB型骨折中的應(yīng)用[J].中醫(yī)正骨,2022,34(11):7-13.
　ZHANG Chuankai,HAO Liang,CHEN Qiang,et al.Application of coracoclavicular ligament reconstruction using suture anchors in surgery of anatomic locking plate internal fixation for treatment of Neer typeⅡB distal clavicle fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(11):7-13.
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帶線錨釘重建喙鎖韌帶在解剖鎖定鋼板內(nèi)固定治療鎖骨遠端NeerⅡB型骨折中的應(yīng)用()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年11期
頁碼:
7-13
欄目:
臨床研究
出版日期:
2022-11-11

文章信息/Info

Title:
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:
張傳開; 郝亮; 陳強; 蔣守海; 邱東新
(徐州仁慈醫(yī)院,江蘇 徐州 221000)
Author(s):
ZHANG Chuankai; HAO Liang; CHEN Qiang; JIANG Shouhai; QIU Dongxin
Xuzhou Renci Hospital,Xuzhou 221000,Jiangsu,China
關(guān)鍵詞:
鎖骨;  肩骨折;  骨折固定術(shù); 內(nèi);  骨板;  縫合錨;  喙鎖韌帶
Keywords:
clavicle;  shoulder fractures;  fracture fixation; internal;  bone plates;  suture anchors;  coracoclavicular ligament
摘要:
目的:探討帶線錨釘重建喙鎖韌帶在解剖鎖定鋼板內(nèi)固定治療鎖骨遠端NeerⅡB型骨折中的應(yīng)用價值。方法:回顧性分析2018年1月至2021年1月收治的146例鎖骨遠端NeerⅡB型骨折患者的病例資料,其中新鮮骨折100例、陳舊性骨折46例,新鮮骨折中54例采用解剖鎖定鋼板內(nèi)固定治療(新鮮單純組)、46例采用解剖鎖定鋼板內(nèi)固定聯(lián)合帶線錨釘重建喙鎖韌帶治療(新鮮聯(lián)合組),陳舊性骨折中26例采用解剖鎖定鋼板內(nèi)固定治療(陳舊單純組)、20例采用解剖鎖定鋼板內(nèi)固定聯(lián)合帶線錨釘重建喙鎖韌帶治療(陳舊聯(lián)合組)。比較新鮮骨折、陳舊性骨折中2組患者的骨折愈合時間、Constant-Murley肩關(guān)節(jié)功能評分、喙鎖間隙增加率、肩部疼痛視覺模擬量表(visual analogue scale,VAS)評分。結(jié)果:所有患者均獲隨訪,隨訪時間6～13個月,中位數(shù)9.5個月。2組新鮮骨折患者的骨折愈合時間及末次隨訪時的肩部疼痛VAS評分、喙鎖間隙增加率、Constant-Murley肩關(guān)節(jié)功能評分比較,組間差異均無統(tǒng)計學意義[(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]; 末次隨訪時2組患者的Constant-Murley肩關(guān)節(jié)功能評分均較術(shù)前增加(t=-39.252,P=0.001; t=-43.710,P=0.001)。2組陳舊性骨折患者末次隨訪時的肩部疼痛VAS評分比較,差異無統(tǒng)計學意義[(3.37±1.11)分,(3.84±1.18)分,t=-1.385,P=0.173]; 陳舊單純組的骨折愈合時間長于陳舊聯(lián)合組,末次隨訪時的喙鎖間隙增加率高于陳舊聯(lián)合組[(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],末次隨訪時的Constant-Murley肩關(guān)節(jié)功能評分低于陳舊聯(lián)合組[(83.45±5.28)分,(93.57±6.04)分,t=-6.053,P=0.001]; 末次隨訪時2組患者的Constant-Murley肩關(guān)節(jié)功能評分均較術(shù)前增加(t=-22.115,P=0.001; t=-23.738,P=0.001)。結(jié)論:對于新鮮鎖骨遠端NeerⅡB型骨折,采用解剖鎖定鋼板內(nèi)固定治療時不需要采用帶線錨釘重建喙鎖韌帶; 但對于陳舊性鎖骨遠端NeerⅡB型骨折,采用解剖鎖定鋼板內(nèi)固定治療時采用帶線錨釘重建喙鎖韌帶,可促進骨折愈合、減小喙鎖間隙、促進肩關(guān)節(jié)功能恢復(fù)。
Abstract:
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 vs 12.89±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±1.18 points,t=-1.385,P=0.173).Compared with the old-combination group,the old-blank group showed prolonged healing time and higher increase rate of coracoclavicular space at last follow-up(19.47±6.34 vs 12.81±3.28 weeks,t=4.271,P=0.001; 21.59±13.15 vs 12.17±6.38%,t=2.943,P=0.005).The CMS of the old-blank group at the last follow-up was lower than that of the old-combination group(83.45±5.28 vs 93.57±6.04 points,t=-6.053,P=0.001).At the last follow-up,the CMS of the two groups was higher than that of pre-surgery(t=-22.115,P=0.001; t=-23.738,P=0.001).Conclusion:Coracoclavicular ligament reconstruction using suture anchors is not required in surgery of anatomical locking plate internal fixation for treatment of fresh Neer typeⅡB distal clavicle fractures.For old Neer type Ⅱ B distal clavicle fractures,however,coracoclavicular ligament reconstruction using suture anchors can facilitate fracture healing,reduce the coracoclavicular space,and promote the recovery of shoulder joint function in surgery of anatomical locking plate internal fixation.

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備注/Memo

備注/Memo:
通訊作者:張傳開 E-mail:[email protected]
更新日期/Last Update: 1900-01-01