阮康明 陈雁华 陈少坚 高连云 吴涛华

[摘要] 目的 探讨锁骨远端解剖锁定钢板倒置内固定联合保护锁骨上神经治疗锁骨近端骨折疗效分析。 方法 对2015年3月～2017年3月我院收治的16例锁骨近端骨折行锁骨上神经保护及锁骨远端解剖锁定钢板倒置内固定术的患者进行回顾性分析。 结果 16例锁骨近端骨折患者均获得随访，所有患者均获得骨性愈合，均未出现内固定失效。采用Rockwood评分法对术后患肢进行评价，优14例，良1例，優良率93%。术后9例患者未见锁骨上神经损伤表现，7例出现不同程度感觉减退，后期随访3例患者残留轻度麻木症状。DASH评分：（8.1±1.3）分。结论 锁骨远端解剖锁定钢板倒置内固定联合保护锁骨上神经治疗锁骨近端骨折固定牢靠，贴敷性好，有助于早期功能锻炼，感觉障碍区域较少，疗效满意。

[关键词] 锁骨近端骨折；锁骨上神经；锁骨远端解剖锁定钢板；钢板倒置

[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701（2018）30-0064-04

[Abstract] Objective To discuss and analyze the effectiveness of inverted distal clavicle anatomical locking plate associating with protecting supraclavicular nerve on fracture of proximal clavicle. Methods Clinical data of 16 patients with fracture of proximal clavicle treated by supraclavicular nerve preservation and distal clavicle anatomic locking plate internal fixation were retrospectively analyzed from March 2015 to March 2017. Results All patients after treatment were followed up， all of them were found bone union with no internal fixation failure. According to Rockwood scoring method， the results were excellent in 14 cases， good in 1 case， the excellent and good rate was 93%. There were no signs of supraclavicular nerve injury in 9 patienets， but 7 patients suffered from varying degrees of hypoesthesia. After the treatment of neurotrophic nerve， 3 patients with mild local lesions symptoms. Disability of Arm Shoulder and Hand score was（8.1±1.3）. Conclusion The method of inverted distal clavicle anatomical locking plate associating with protecting supraclavicular nerve on fracture of proximal clavicle has advantages of stable fixation， with good conformity， early functional exercise， less sensory regional disturbance and definite therapeutic effects.

[Key words] Proximal clavicle fracture； Nervi supraclaviculares； Distal clavicle anatomical locking plate； Plate inversion

锁骨骨折是临床较常见的骨折之一，约占所有骨折的2.6%～12.0%[1-2]，以锁骨中1/3 骨折最常见，占锁骨骨折的69%～82%，锁骨中外1/3骨折占锁骨骨折的21%～28%[3]，锁骨内1/3骨折发病率极低，占锁骨骨折的2%～3%[4]。锁骨近端骨折发病率低，且目前对锁骨近端骨折保守治疗的效果不理想。随着患者对临床疗效的要求越来越高，对于运动量大或年轻的患者，切开复位钢板内固定治疗锁骨近端骨折已成为主流方法[5-6]。传统切开复位钢板内固定手术不重视锁骨上神经的保护，术后患者常出现患肩、胸外上部皮肤感觉障碍，影响生活及心理质量。……