Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (30): 4877-4882.doi: 10.12307/2021.277
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Wei Yongan, Zhou Jihui, Chen Wenyao, Li Bo, Huang Jing, Wang Jie, Zhu Xiaokang, Li Xinzhi
Received:
2020-12-21
Revised:
2020-12-24
Accepted:
2021-02-05
Online:
2021-10-28
Published:
2021-07-29
Contact:
Li Xinzhi, MD, Chief physician, Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang 443001, Hubei Province, China
About author:
Wei Yongan, Master candidate, Attending physician, Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang 443001, Hubei Province, China
CLC Number:
Wei Yongan, Zhou Jihui, Chen Wenyao, Li Bo, Huang Jing, Wang Jie, Zhu Xiaokang, Li Xinzhi. Treatment of distal clavicle fractures and selection of implants[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(30): 4877-4882.
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2.1 锁骨远端骨折的基本特点 锁骨远端骨折是指发生于锁骨外侧端1/3的骨折,在所有类型的锁骨骨折中约占20%。锁骨远端通过肩锁韧带及关节囊及肩胛骨相连,连同锁骨与喙突之间的喙锁韧带构成肩关节上方悬吊带复合体的重要组成部分,锁骨远端骨折不仅波及骨质,同时可造成韧带及关节囊损伤,远骨折段相对短小,难以确切固定,骨折不愈合及畸形愈合的发生率较高。临床常用于成人锁骨远端骨折的分型是Neer分型,同时兼顾了骨折损伤移位情况及韧带损伤情况,对治疗有较好的指导意义。不稳定的Neer Ⅱ型及Neer Ⅴ型骨折伴有喙锁韧带损伤;Neer Ⅱa型骨折发生在喙锁韧带的近端,不伴有韧带的损伤,近骨折段失去韧带的把持向上方移位明显;Neer Ⅱb型骨折发生在喙锁韧带附着区,伴有韧带的断裂,骨折端移位明显;Neer Ⅴ型骨折是包括喙锁韧带附着区游离骨块的粉碎性骨折,上述3类骨折稳定性差,骨不连的发生率高,易导致骨折畸形愈合,需手术治 疗[2]。术前的影像学检查可以判断出骨折类型为手术方案提供依据,X射线片检查是必要的,但平面成像并不能反映出详尽的骨折情况,CT影像可对骨折的形态进行多层次分析,同时可对韧带损失情况做出间接判断,术前进行CT检查对于骨折的分析更加有利。 2.2 手术治疗及内置物的选择 2.2.1 锁骨钩钢板 锁骨钩钢板是针对肩锁关节脱位及锁骨远端骨折设计的内置物体,特有的外侧钩形结构伸入肩峰下,钩紧肩峰下面形成远端的稳定;手术时需要显露肩锁关节,尾钩与钉板系统形成的力学稳定性可满足锁骨远端骨折的稳定需要,治疗锁骨远端骨折临床疗效较好[3],但其并发症发生率较高,如肩峰磨损、肩峰撞击、肩袖损伤等,部分患者术后有明显的不适感,早期不能进行功能锻炼,需二次手术取出[4]。ZHANG等[5]认为钩钢板手术后的功能和并发症发生率与取出的时间密切相关,3个月内取出功能最佳,并发症发生率最低,并发症的发生率明显低于术后3-6个月取出者及术后6个月以后取出者,而术后3-6个月取出者并发症的发生率低于术后6个月以后取出者,建议在术后情况允许时尽早取出钩钢板。经典的AO钩钢板远端螺钉孔较少,对相对短小的远骨折段固定强度有限,针对这一缺陷,一种新型钩钢板在远端采用了多孔设计,主要用于治疗Neer Ⅴ型骨折,远端可打入多枚螺钉固定,与尾钩结构配合增加固定强度,SEO等[6]认为这种新型钩钢板使愈合时间和内固定取出时间更短,治疗满意率更高,但尾钩结构导致的并发症率无明显改善。 2.2.2 锁定钢板 锁定钢板可避免钩形结构导致的不适及并发症,对远骨折段的确切固定是其需解决的关键问题。带有外侧延伸部的3.5 mm锁定钢板与锁骨外侧段形态符合,预弯后与锁骨远端更加贴附,延伸部有多孔设计,可打入多枚2.4-2.7 mm锁定螺钉,VAISHYA等[7]认为这种钢板对骨折把持能力更强,是锁骨远端骨折有效治疗手段。IBRAHIM等[8]采用前外侧入路,从肌肉间隙进入,锁定钢板放置于锁骨远端前外侧,使钢板更易与锁骨贴附,术中用克氏针临时固定,2 mm拉力螺钉辅助固定细小骨折块,螺钉经埋头处理后钉帽与骨皮质相平或略低调于骨面,可避免对放置钢板造成干扰,术中可同时探查喙锁韧带情况,必要时进行韧带重建处理。TIEFENBOECK等[9]通过锁定钢板的螺钉孔应用长螺钉进行钢板与喙突固定,认为此方法能够增加固定的稳定性,螺钉的刚性强度并不符合弹性固定的生物力学特点,易发生断裂,喙突螺钉需根据愈合情况及时取出。ABDELDAYEM等[10]使用桡骨远端钢板横行放置治疗Neer Ⅱ型锁骨远端骨折,利用钢板远端的多孔设计固定短小的远端骨折块,可进行预弯处理,螺钉直径相对较小,内固定不需取出。双钢板垂直固定技术也被应用于锁骨远端骨折,SUTER等[11]将2块钢板分别放置于锁骨的上面及前缘,使远端骨折块得到更加稳定的固定,但此方法也存在费用高、局部剥离范围大等缺点,未成为主流的固定方式。 2.2.3 喙锁韧带的重建及加强技术 近年来喙锁韧带在锁骨远端乃至整个肩关节上方悬吊带复合体稳定性中的重要作用越来越受到重视,喙锁韧带的重建及加强术也逐渐成为针对锁骨远端骨折的主流术式[12]。可选用的重建材料包括缝线、锚钉、带袢纽扣钢板(Endobutton)、钛缆、自体肌腱、异体肌腱、人工肌腱等。SARDA[13]利用“T”形切开在锁骨及喙突部建立手术窗,在锁骨近侧骨干由后向前斜形钻孔,强力缝线绕过喙突基底部向上穿过锁骨孔道拉紧固定,另一道缝线环绕锁骨干及喙突底部作为加强,还可用缝线形成近端骨折段与肩锁韧带之间的“8”字固定,缝线技术在力学性能上尚存在不足,未被广泛采用。FANG等[14]使用锚钉技术锚定喙突骨质,可经过隧道穿过锁骨或环绕锁骨重建喙锁韧带,经影像学追踪术后锁骨喙突间隙虽然略有增大,但差异无显著性意义,说明锚钉技术是治疗锁骨远端骨折是可行的方法。近年单独应用钛缆治疗锁骨远端骨折的相关文献较少,钛缆的生物力学强度略低于正常喙锁韧带[15-16],多数学者将其作为联合固定的手段之一。用来移植重建喙锁韧带的肌腱包括腓骨长短肌腱、股薄肌腱、半腱肌腱、人工肌腱等[2,17-19],更符合生物力学要求,因取腱造成的损伤及并发症、异体肌腱的排斥反应、人工肌腱价格昂贵、手术操作复杂等原因未得到广泛推广。Endobutton技术近年来逐渐成为肌腱重建的主流术式,关节镜下应用此项技术的报道较多[20-21],具有微创、复位确切、可探查处理其他软组织损伤、对肩部结构影响小等优点,但需要熟练掌握肩关节镜技术。对于易复位的骨折可采用经皮微创应用Endobutton技术[22-23],即使切开运用此项技术,只需进行局部显露,创伤较小,具有稳定性良好、符合局部力学性能、二次手术率低等优势[24]。LIM等[25]总结了关节镜下Endobutton技术韧带重建的术中及术后并发症,主要包括术中喙突皮质断裂、术后韧带骨化、锁骨隧道增宽、锁骨侵蚀、复位丢失、感染等,与操作者的熟练程度及技术水平有关,说明关节镜下操作有更高的技术要求。 2.2.4 其他内置物 克氏针张力带技术早期被应用于治疗锁骨远端骨折,因发生内固定失效及局部刺激等并发症较多逐渐被淘汰,对于锁骨远端骨折难以达到稳定的要求,目前克氏针多作为辅助固定的手段[26]。钛制弹性钉主要用于治疗儿童管状骨骨折,JEON等[27]对轻度移位的儿童锁骨远端骨折采用闭合复位,弹性钉自外向内穿过断端骨质,实现了髓内微创治疗的目的。MATSUMURA等[28]对于长斜形骨折而喙锁韧带无损伤的病例,采用环扎线治疗技术,认为可有限切开,实现微创治疗的目的,弹性钉及环扎线固定确切程度较差,仅见于病例报告。陶金国等[29]认为桥接组合式钉棒系统可实现多点、三维固定,根据骨折粉碎程度可选择一两根桥接棒,不剥离骨膜,不影响肩锁关节的功能,近期临床疗效较好。针对伴有喙锁韧带损伤的锁骨远端骨折,韧带修复与其他固定方式联合应用可获得更稳固的效果[30-33],对骨折及韧带损伤实现全面、稳定的治疗,无论从影像学及功能评分等方面均获得满意效果。 2.3 内置物之间的比较研究 关于内置物治疗锁骨远端骨折临床效果的研究较多。FOX等[34]比较了袢钢板、钩钢板、锁定钢板治疗NEER Ⅱ型骨折的疗效,发现袢钢板是更行之有效的固定方式,其他两种术式术后的再次手术率比较高,原因包括不稳定导致畸形愈合、内置物被迫取出、感染需要清创、骨折不愈合等。LI等[35]比较了解剖型钢板固定、钩钢板固定、双钢板垂直固定、T型钢板固定治疗锁骨远端骨折的临床效果,4种方法均可获得较好的临床疗效,双钢板垂直固定及解剖钢板固定的并发症率比较低,肩关节术后可更早进行功能锻炼,肩关节功能恢复更好,患者自觉症状更优。较多的研究认为锁定钢板与钩钢板的疗效相当,除优于传统的克氏针张力带固定外,钩钢板的并发症率更高,患者舒适感差,术后早期肩部功能恢复稍差[36-37]。与钢板技术相比,通过手术时间、失血量、住院时间、影像学评价、肩关节功能等方面综合分析,喙锁韧带修复重建技术越来越成为众多学者认同的主流术式,这是由其固定稳定、更加符合生物力学要求、并发症率低、无需取出内固定、患者舒适感及满意度高、肩关节功能恢复佳所决定的[38-39]。 在尸体标本模型上测试内置物固定生物力学方面的比较研究提供了更加可靠的依据。SUTER等[40]通过力学负荷测试了双钢板固定与解剖钢板固定的力学性能,发现解剖钢板所能承载的负荷略大,但二者之间差异无显著性意义,说明二者均能满足固定强度的要求,固定失效后双钢板固定尸体标本的移位程度更明显。YAGNIK等[41]测试了锁定钢板组、锁定钢板加袢钢板组、袢钢板组、袢钢板加半腱肌移植重建韧带组的力学性能,在尸体标本中经循环载荷使骨折移位 10 mm至完全移位,锁定钢板组所能承受的力学载荷明显低于其余各组,袢钢板组承受的力学载荷略低于其余两组,但差异无显著性意义,说明喙锁韧带重建能够明显增加力学稳定性,袢钢板作为锁骨远端骨折是理想的内置物选择。 2.4 其他相关研究 CHECHIK等[42]认为横行切口与纵行切口治疗锁骨骨折均能较好显露术区,纵行切口的手术瘢痕更小,但其局部血肿的发生率更高,需要更加精细的缝合。权冬等[43]认为切开时应注意保护锁骨上神经,锁骨上神经损伤后会导致支配区皮肤感觉迟钝或发生痛觉过敏,皮肤营养状态下降,局部硬化,并可部分影响患肩的外展功能,手术中应在皮下脂肪层找到锁骨上皮神经进行保护,利于患者功能恢复和舒适度的提高。KLUIJFHOUT等[44]通过分析手术时间与并发症的相关性得出结论,有手术指征的患者应尽早接受手术,保守治疗或延期手术者并发症发生率较高。CHEN等[45]应用盐酸肾上腺素、硫酸吗啡、罗哌卡因、生理盐水混合后在锁骨远端骨折术区注射,能够促进术区止血,有效缓解术后疼痛,增加患者舒适感,利于快速康复。YOO等[46]通过分析锁骨远端的骨质特点得出结论,锁骨锥状结节和结节间的骨密度和皮质厚度均明显增加,差异有显著性意义,说明内固定物经此区域可获最佳固定效果。"
[1] OCKERT B, WIEDEMANN E, HAASTERS F. Distal clavicle fractures. Classifications and management. Unfallchirurg. 2015;118(5):397-406. [2] KENNEDY MI, PEEBLES LA, PROVENCHER MT, et al. Acromioclavicular and Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Instability. JBJS Essent Surg Tech. 2019;9(4):1-2. [3] XUE L, CHEN Q, ZHOU Z. Clinical effects of clavicular hook plate for Neer type II fracture of distal clavicle. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007;21(9):979-981. [4] LOPIZ Y, CHECA P, GARCÍA-FERNÁNDEZ C, et al. Complications with the clavicle hook plate after fixation of Neer type II clavicle fractures. Int Orthop. 2019;43(7):1701-1708. [5] ZHANG L, XIAO H, GAO Y, et al. Late function and complications of hook plate implantation for distal-third clavicle fractures : a retrospective study. Acta Orthop Belg. 2018;84(4):485-490. [6] SEO J, HEO K, KIM SJ, et al. Comparison of a novel hybrid hook locking plate fixation method with the conventional AO hook plate fixation method for Neer type V distal clavicle fractures. Orthop Traumatol Surg Res. 2020;106(1):67-75. [7] VAISHYA R, VIJAY V, KHANNA V. Outcome of distal end clavicle fractures treated with locking plates. Chin J Traumatol. 2017;20(1): 45-48. [8] IBRAHIM S, MELEPPURAM JJ. Retrospective study of superior anterior plate as a treatment for unstable (Neer type 2) distal clavicle fractures. Rev Bras Ortop. 2018;53(3):306-313. [9] TIEFENBOECK TM, BOESMUELLER S, BINDER H, et al. Displaced Neer Type IIB distal-third clavicle fractures-Long-term clinical outcome after plate fixation and additional screw augmentation for coracoclavicular instability. BMC Musculoskelet Disord. 2017;18(1):30. [10] ABDELDAYEM A, NAFEA W, EID A. Treatment of unstable distal third clavicular fracture with locked distal radius plate. J Orthop. 2013;10(4): 168-171. [11] SUTER C, VON ROHR M, MAJEWSKI M, et al. Biomechanical comparison of two plating techniques in lateral clavicle fractures. Clin Biomech (Bristol, Avon). 2019;67:78-84 . [12] 周军,李潇,刘益民,等. 锁骨远端不稳定性骨折治疗需重视喙锁韧带的修复[J].中国骨与关节杂志 ,2019,8(11):801-803. [13] SARDA P. Lateral Clavicle Fractures with Coracoclavicular Ligament Disruption (Neer’s Type IIB): Review of Literature and a New Technique for All-Suture Fixation. Indian J Orthop. 2019;53(3):465-471. [14] FANG JH, TANG GL, CHEN H, et al. Application of the method of anatomic coracoclavicular ligament reconstruction for distal clavicle fractures. Zhonghua Yi Xue Za Zhi. 2017;97(13):1011-1014. [15] LI Y, SHI S, OU-YANG YP, et al. Minimally invasive treatment for Neer IIb distal clavicle fractures with titanium cable. J Trauma. 2011;71(2):E37-40. [16] 金翔赟,沈一凡,李广翼,等.带锚钛缆重建喙锁韧带的生物力学研究[J]. 国际骨科学杂志,2019,40(3):187-190. [17] GARCÍA-GARCÍA R, MERCADO-COLÍN JM. Coracoclavicular ligaments reconstruction with short lateral peroneal autologous tendon graft. Acta Ortop Mex. 2019;33(2):88-95. [18] NORDIN JS, OLSSON O, LUNSJÖ K. The gracilis tendon autograft is a safe choice for orthopedic reconstructive procedures: a consecutive case series studying the effects of tendon harvesting. BMC musculoskeletal disorders. 2019;20(1):138. [19] RANNE JO, KAINONEN TU, LEMPAINEN LL, et al. Arthroscopic Coracoclavicular Ligament Reconstruction Using a Synthetic Polycaprolactone-Based Polyurethane Urea Tendon Graft: A Report of 5 Cases. Surg Innov. 2018;25(3):224-229. [20] 王鹏云, 鞠俊莲, 蔡金宏,等.关节镜下双 Endobutton 袢钢板技术治疗NeerⅡB 型骨折[J]. 广东医学,2019,40(2):3162-3167. [21] SAUTET P, GALLAND A, AIRAUDI S, et al. Arthroscopy-assisted fixation of fracture of the distal part of the clavicle by subcoracoid suture and clavicle button. Orthop Traumatol Surg Res. 2018;104(8):1237-1240. [22] MANOHARA R, REID JT. Percutaneous endobutton fixation of acute acromioclavicular joint injuries and lateral clavicle fractures. J Clin Orthop Trauma. 2019;10(3):492-496. [23] BRANDARIZ RN, BRUCHMANN MG, DE CICCO FL, et al. Coracoclavicular Double-Button Fixation of Displaced Lateral Clavicular Fracture in a Patient without Coracoid Process. Case Rep Orthop. 2019;2019: 6506951. [24] 鲁驷原, 冯宏伟, 张建洛, 等. 双带袢钢板技术治疗 NeerⅡ型锁骨远端骨折的疗效分析[J]. 创伤外科杂志,2017,19(10):741-745. [25] LIM TK, OH WK. Intraoperative and Postoperative Complications after Arthroscopic Coracoclavicular Stabilization. Clinics in orthopedic surgery. 2019;11(1):103-111. [26] 钟园, 胡晓音, 占新华, 等. 锁骨远端解剖锁定钢板联合克氏针内固定治疗 Neer Ⅱ b 型锁骨远端骨折[J]. 中国骨与关节损伤杂志, 2018,33(9):980-981. [27] JEON YM, KO BS, PARK JW. Distal clavicle fracture treated with a titanium elastic nail (TEN) . Trauma Case Rep. 2019;9:11-14. [28] MATSUMURA N, TAKADA Y, SETO T, et al. Cerclage Wiring Fixation for the Treatment of Long Oblique Fractures of the Distal Clavicle: A Report of 2 Cases. JBJS Case Connect. 2019;9(4):e0085. [29] 陶金国, 杨俊宇, 段洪, 等. 桥接组合式钉棒系统与锁骨钩钢板固定治疗锁骨远端骨折的近期临床疗效观察[J]. 生物骨科材料与临床研究,2019,16(5):75-80. [30] XU H, CHEN WJ, ZHI XC, et al. Comparison of the efficacy of a distal clavicular locking plate with and without a suture anchor in the treatment of Neer IIb distal clavicle fractures. BMC Musculoskelet Disord. 2019;20(1):503. [31] MOCHIZUKI Y, KANEKO T, KAWAHARA K, et al. Outcome of arthroscopy-assisted treatment for distal clavicle fractures. Arch Orthop Trauma Surg. 2019;139(10):1393-1398. [32] 章慧斌,郑慷,应弋阳.钩钢板联合韧带重建治疗Tossy Ⅲ型肩锁关节脱位及Neer Ⅱ型锁骨远端骨折[J]. 浙江创伤外科,2012,17(3): 317-318. [33] 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. Orthop J Sports Med. 2019;7(9):2325967119867920. [34] FOX HM, RAMSEY DC, THOMPSON AR, et al. Neer Type-II Distal Clavicle Fractures: A Cost-Effectiveness Analysis of Fixation Techniques. J Bone Joint Surg Am. 2020;102(3):254-261. [35] LI L, WU H, JIANG P, et al. Comparison of four different internal fixation methods in the treatment of distal clavicle fractures. Exp Ther Med. 2020;19(1):451-458. [36] Li L, Li TY, Jiang P, et al. Clavicle hook plate versus distal clavicle locking plate for Neer type II distal clavicle fractures. J Orthop Surg Res. 2019;14(1):472. [37] ASADOLLAHI S, BUCKNILL A. Hook Plate Fixation for Acute Unstable Distal Clavicle Fracture: A Systematic Review and Meta-analysis. J Orthop Trauma. 2019;33(8):417-422. [38] ZHANG YF, MI M, ZHANG J, et al. Case-control study on single locking plate and locking plate with suture anchors for the treatment of unstable distal clavicle fractures. Zhongguo Gu Shang. 2019;32(1): 11-16. [39] 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. [40] SUTER C, VON ROHR M, MAJEWSKI M, et al. Biomechanical comparison of two plating techniques in lateral clavicle fractures. Clin Biomech (Bristol, Avon). 2019;67:78-84 . [41] YAGNIK GP, BRADY PC, ZIMMERMAN JP, et al. A biomechanical comparison of new techniques for distal clavicular fracture repair versus locked plating. J Shoulder Elbow Surg. 2019;28(5):982-988. [42] CHECHIK O, BATASH R, GOLDSTEIN Y, et al. Surgical approach for open reduction and internal fixation of clavicle fractures: a comparison of vertical and horizontal incisions. Int Orthop. 2019;43(8):1977-1982. [43] 权冬,刘雯,辛忍,等.保留锁骨上神经对锁骨中远端骨折内固定患者的影响[J]. 临床医学,2018,3(4):37-38. [44] KLUIJFHOUT WP, TUTUHATUNEWA ED, VAN OLDEN GDJ. Plate fixation of clavicle fractures: comparison between early and delayed surgery. J Shoulder Elbow Surg. 2020;29(2):266-272. [45] CHEN RE, SOIN SP, EL-SHAAR R, et al. What Regions of the Distal Clavicle Have the Greatest Bone Mineral Density and Cortical Thickness? A Cadaveric Study. Clin Orthop Relat Res. 2019;477(12): 2726-2732. [46] YOO JS, HEO K, KWON SM, et al. Effect of Surgical-Site, Multimodal Drug Injection on Pain and Stress Biomarkers in Patients Undergoing Plate Fixation for Clavicular Fractures. Clin Orthop Surg. 2018;10(4): 455-461 . [47] KIM SM, CHA B, JEONG KS, et al. Clinical factors in patients with congenital muscular torticollis treated with surgical resection. Arch Plast Surg. 2019;46(5):414-420. [48] MENDES JÚNIOR AF, MOTA NETO JD, DIAS DM, et al. Functional and Radiological Outcomes of the Surgical Treatment of Acute Acromioclavicular Dislocation with Anchors Associated with Clavicle and Scapula Fixation. Rev Bras Ortop (Sao Paulo). 2019;54(6): 649-656 . |
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