解剖型锁定钢板对锁骨远端骨折内固定术后肩锁关节三维形态的影响

Effect of anatomical locking plate on the three-dimensional morphology of acromioclavicular joint after internal fixation for distal clavicle fractures

摘要:

目的 分析解剖型锁定钢板对锁骨远端骨折内固定术后肩锁关节的三维形态的影响。方法 选取2018年3月—2021年2月江苏省苏北人民医院收治的92例锁骨远端骨折患者。其中48例采用解剖型锁定钢板内固定作为研究组，44例采用重建钢板开放复位内固定作为对照组。比较两组患者手术及骨折愈合情况，比较两组患者肩关节功能、疼痛、骨折复位质量、肩锁关节的三维形态及并发症情况。结果 研究组手术时间、切口总长度、骨折愈合时间短于对照组，术中出血量低于对照组（P <0.05）。研究组手术前后Constant-Murley评分、Neer评分差值高于对照组，手术前后喙锁间距、前屈活动度、外旋活动度、肩峰下间隙差值大于对照组（P <0.05）。两组患者术前、术后1个月、术后3个月的VAS评分比较，经重复测量设计的方差分析，结果 ①不同时间点的VAS评分有差异（P <0.05）；②两组患者VAS评分有差异（P <0.05）；③两组患者VAS评分变化趋势有差异（P <0.05）。两组患者术后骨折复位质量比较，差异无统计学意义（P >0.05）。两组总并发症发生率比较，差异无统计学意义（P >0.05）。结论 与重建钢板开放复位内固定比较，解剖型锁定钢板用于锁骨远端骨折具有手术创伤小、骨折愈合时间短、肩关节功能恢复佳、术后疼痛轻、肩锁关节三维形态改善更明显的优点。

Abstract:

Objective To analyze the effect of anatomical locking plate on the three-dimensional morphology of the acromioclavicular joint after internal fixation for distal clavicle fractures.Methods The clinical data of 92 patients with distal clavicle fractures treated in our hospital from March 2018 to February 2021 were reviewed, of which 48 were treated with anatomical locking plate internal fixation (study group), and 44 were treated with reconstructive plate for open reduction and internal fixation (control group). The operation and fracture healing of the two groups were compared. The shoulder joint function, pain, fracture reduction quality, three-dimensional morphology of the acromioclavicular joint and the incidence of complications were analyzed between the two groups.Results Compared with the control group, the operative duration, total incision length and fracture healing time were shorter and intraoperative blood loss was lower in the study group (P < 0.05). The differences of Constant-Murley score and Neer score before and after the operation were higher in the study group than those in the control group (P < 0.05). The coracoclavicular distance, the range of motion for anteflexion and external rotation, and the subacromial space were increased in the study group relative to the control group (P < 0.05). The Visual Analog Scale (VAS) scores before the operation, and 1 month and 3 months after the operation in the two groups were compared via repeated measures analysis of variance, which revealed that the VAS scores were different at different time points (P < 0.05) and between the study group and control group (P < 0.05), and that the change trends of VAS scores were different between the two groups (P < 0.05). There was no significant difference in the quality of postoperative fracture reduction between the two groups (P > 0.05). The overall incidence of complications was comparable between the two groups (P > 0.05).Conclusions Compared with the reconstructive plate for open reduction and internal fixation, the anatomical locking plate has the advantages of less surgical trauma, shorter fracture healing time, better shoulder joint function recovery, less postoperative pain, and more remarkable improvement in the three-dimensional morphology of the acromioclavicular joint in treating distal clavicle fractures.