双袢钢板加压螺钉与钩钢板固定Neer IIB型锁骨远端骨折△（开放获取）

Double loop plate combined with compression screw versus hook plate for Neer type IIB distal clavicle fractures (OA)

摘要:

[目的] 比较双袢钢板联合加压螺钉与锁骨钩钢板治疗 Neer IIB 型锁骨远端骨折的临床效果。[方法] 回顾性分析 2020 年 1 月—2022 年 12 月 Neer II 型锁骨远端骨折接受手术治疗的 61 例患者的临床资料，按术前医患沟通结果，30 例采用双袢钢板-加压螺钉内固定（袢板组），31 例采用锁骨钩钢板内固定（钩板组）。比较两组围手术期、随访和影像指标。[结果]袢板组切口长度 [(4.5±0.4) cm vs (7.7±0.6) cm, P＜0.001]、术中失血量 [(46.7±6.9) ml vs (66.9±8.8) ml, P＜0.001]、主动活动时间 [(25.4± 1.5) d vs (30.0±1.8) d, P＜0.001] 均显著优于钩板组，但前者的手术时间显著长于后者 [(69.5±7.8) min vs (62.7±7.7) min, P＜0.001]。袢板组完全持重活动时间 [(84.1±5.7) d vs (87.3±6.1) d, P=0.039] 显著早于钩板组。随时间推移，两组 VAS 评分均显著减少 （P＜ 0.05），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）。术后 3 个月、末次随访时袢板组的上述指标均显著优于钩板组（P＜0.05）。影像方面，袢板组骨折复位质量显著优于钢板组 [优/良/差, (19/10/1) vs (9/20/2), P= 0.027]。两组患者术后喙锁距离（coracoclavicular distance, CCD）均显著减小（P＜0.05），术后 3 个月及末次随访时，袢板组 CCD 均显著小于钢板组（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] 双袢钢板联合加压螺钉比传统的锁骨钩钢板治疗 Neer IIB 型锁骨远端骨折具有微创、对术后关节功能影响小、并发症少等优点，临床疗效满意。

Abstract:

[Objective] To compare the clinical outcomes of double loop plate combined with compression screw (DLP) versus clavicular hook plate (HP) in the treatment of Neer type IIB distal clavicular fractures. [Methods] A retrospective study was done on 61 patients who received surgical treatment for Neer type IIB distal clavicular fractures from January 2020 to December 2022. According to the preoperative doctor-patient communication, 30 cases were treated with DLP, while the remaining 31 patients were treated with the HP. The perioperative period, followup and imaging data were compared between the two groups. [Results] The DLP group proved significantly superior to the HP group in terms of incision length [(4.5±0.4) cm vs (7.7±0.6) cm, P＜0.001], intraoperative blood loss [(46.7±6.9) ml vs (66.9±8.8) ml, P＜0.001] and active activity time [(25.4±1.5) days vs (30.0±1.8) days, P＜0.001], despite of the fact that the former consumed significantly longer operative time than the latter [(69.5±7.8) min vs (62.7±7.7) min, P＜0.001]. In addition, the DLP group regained full weight bearing activitysignifi-cantly earlier than HP group [(84.1±5.7) days vs (87.3±6.1) days, P=0.039]. As time went on, VAS scores were significantly decreased (P＜ 0.05), whereas Constant-Murley scores, abduction-uplifting, forward flexion-uplifting and internal and external rotation range of motion (ROMs) of the shoulder significantly increased in both groups (P＜0.05). The DLP group proved significantly better than the HP group in abovesaid items at 3 months postoperatively and the last follow-up (P＜0.05). As for imaging, fracture reduction quality in the DLP group was also significantly better than that in the HP group [excellent/good/poor, (19/10/1) vs (9/20/2), P=0.027]. The postoperative coracoclavavicular distance (CCD) in both groups significantly reduced compared with that preoperatively (P＜0.05), which in the DLP group was significantly smaller than that of in the HP group 3 months after the operation and the last follow-up (P＜0.05). However, there was no significant difference in fracture healing time between the two groups (P＞0.05). [Conclusion] Compared with traditional clavicular hook plate in the treatment of Neer type IIB distal clavicular fractures, double loops plate combined with compression screw has the advantages of minimally invasive surgery, less influence on postoperative joint function and fewer complications, and more satisfactory clinical consequences.