Specific wedge-shaped bone mass of comminuted fracture of middle clavicle and its clinical significance
锁骨中段粉碎性骨折特定楔形骨块及临床意义

摘要

目的 发现锁骨中段粉碎性骨折时在远折端前侧存在一特定楔形骨块，探讨此骨块在锁骨中段粉碎骨折时存在的机率及临床意义。方法 回顾2018年至2020年3月近27个月我科收治50例锁骨中段粉碎性骨折患者，49例存在此楔形骨块。其中左侧25例，右侧25例，男性43例，女性7例。结果 手术时间45—120分钟，平均（60分钟±2.54），出血20—100mL，平均(40mL±2.12)，所有患者均获得随访，随访时间12—24个月，平均（18个月±1.83）。骨折均完全愈合，愈合时间2—4个月，平均（3.4个月±0.81）。2例患者术后出现钢板变形，但未断裂，骨折畸形愈合，患肢功能无明显受限，未行翻修手术，1例患者诉患侧肩部有下垂感。所有患者未出现切口感染，臂丛神经、血管损伤症状。DSAH评分0—4.1分，平均（0.3分±0.23），Constant-Murley评分90—100分，平均（97.4分±1.2）。结论 50例锁骨中段粉碎性骨折患者，49例存在此楔形骨块，存在率为98%。术中首先处理此骨块，将此骨块复位、使用拉力螺钉固定于骨折远端。这样方便复位骨折端，达到缩短手术时间，减少术中出血，降低感染风险，增加固定稳定，减少钢板应力。能够满足术后早期功能锻炼，利于术后患肢功能恢复，效果满意。

Abstract

Objective To find that there is a specific wedge-shaped bone block on the front side of the distal end in the middle clavicle comminuted fracture, and to explore the probability and clinical significance of this bone block in the middle clavicle comminuted fracture.
Methods From 2018 to March 2020, 50 cases of comminuted fracture of the middle clavicle were treated in our department in recent 27 months, and 49 cases had this wedge-shaped bone mass. Among them, there were 25 cases on the left side, 25 cases on the right side, 43 males and 7 females, with an average age of （35.6±2.97） years. Three-dimensional reconstruction of bilateral shoulders is routinely performed before operation. When patients with this wedge-shaped bone block are operated, the wedge-shaped bone block is firstly reset and fixed at the distal end of the fracture, and the soft tissue attached to the bone block is retained. The 2.7 or 3.5mm system lag screw is routinely used for fixation from front to back, and then the distal and proximal ends of the fracture are reset and fixed, and the steel plate is placed above the clavicle. At one year follow-up, DSAH score of shoulder, arm and hand dysfunction and Constant-Murley score of shoulder joint were used for evaluation.
Results The operation time was 45-120 minutes, with an average of (60± 2.54)minutes and bleeding was 20-100 ml, with an average of (40±2.12) mL. All patients were followed up for 12-24 months, with an average of (18±1.83) months. All fractures healed completely, and the healing time was 2-4 months, with an average of (3.4±0.81) months. Two patients had deformed steel plate after operation, but did not break, the fracture malunion, the function of the affected limb was not obviously limited, and no revision operation was performed. One patient complained that the affected shoulder felt drooping. No wound infection, brachial plexus injury and blood vessel injury occurred in all patients. The DSAH score was 0-4.1, with an average of (0.3±0.23), and the Constant-Murley score was 90-100, with an average of (97.4±1.2).
Conclusion   Among 50 patients with comminuted fracture of the middle clavicle, 49 patients have this wedge-shaped bone mass, and the existing rate is 98%. During the operation, the bone block was firstly treated, and the bone block was reduced and fixed at the distal end of the fracture with lag screws. It is convenient to reduce fracture end, shorten operation time, reduce intraoperative bleeding, reduce infection risk, increase fixation stability and reduce stress of steel plate. It can satisfy the early functional exercise after operation, and is beneficial to the functional recovery of the affected limb after operation with satisfactory results.