摘要目的 探讨反置锁骨远端解剖型锁定钢板治疗移位锁骨近端骨折的临床疗效. 方法 回顾性分析2013年8月至2015年8月采取反置锁骨远端解剖型锁定钢板治疗12例移位锁骨近端骨折患者资料.男11例,女1例;年龄25 ～ 62岁,平均43.5岁;新鲜骨折9例,陈旧性骨折2例,内固定失效翻修1例.骨折按照Edinburgh分型:1B1型10例,1B2型2例.骨折复位后,将同侧锁骨远端解剖型锁定钢板反转180°后放置在锁骨近端上方,近端骨块使用2～4枚2.7 mm锁定螺钉固定,远端骨块使用2～3枚3.5 mm锁定螺钉固定,必要时使用爱惜绑缝线加强固定.采用X线及其CT检查评估骨折复位和愈合情况,末次随访时采用Constant-Murley评分和臂肩手功能障碍评估表(DASH)评定患肢功能. 结果 术中无血管、神经损伤.所有患者术后获12～24个月(平均15.6个月)随访.骨折愈合时间为8～ 24周,平均14.3周.末次随访时Constant-Murley评分为84～100分,平均96.0分;DASH评分为0～14.8分,平均1.9分.术后无一例患者发生感染、复位丢失和内固定失效等. 结论 反置锁骨远端解剖型锁定钢板治疗移位锁骨近端骨折具有固定可靠、稳定性好及术后患者能够早期进行功能锻炼等优点.

abstractsObjective To explore clinical and radiological outcomes of treating displaced fractures of proximal clavicle by open reduction and internal fixation with an inverted anatomic locking plate for distal clavicle.Methods From August 2013 to August 2015,12 patients with displaced fracture of proximal clavicle were treated in our hospital by open reduction and internal fixation with an inverted anatomic locking plate for distal clavicle.They were 11 men and one woman,with an average age of 43.5 years (range,25 to 62 years).There were 9 fresh and 2 old fractures.According to the Edinburgh classification,10 fractures were classified as type 1B1 and 2 as type 1B2.After fixation,the 180° inverted plate on the ipsilateral side was placed on the superior aspect of proximal clavicle.The medial fragment was fixed with 2 to 4 pieces of 2.7 mm multidirectional locking screw and the lateral fragment with 2 to 3 pieces of 3.5 mm locking screw.X-ray and CT were performed to assess union,delayed union,nonunion,and hardware failure.Functional outcomes were assessed by Constant-Murley scores and Disabilities of the Arm,Shoulder and Hand (DASH) scores at final follow-ups.Results There were no significant neurovascular injuries intraoperatively.All patients were followed up for an average of 15.6 months (range,12 to 24 months).All fractures healed after an average of 14.3 weeks (range,8 to 24 weeks).At final follow-ups,the mean Constant-Murley score was 96.0 points (range,84 to 100 points) and the mean DASH score 1.9 points (range,0 to 14.8 points).There were no such significant complications as infection,reduction loss or implant failure.Conclusion Displaced fractures of proximal clavicle may be treated with an inverted anatomic locking plate for distal clavicle on the ipsilateral side because of rigid fixation,fine stability and good chance for early rehabilitation.