锁骨.ppt

锁骨干骨折手术指征和并发症,解 剖,连接自由上肢骨与躯干 一体两端 内侧2/3凸向前，外侧1/3凸向后,解 剖,Abdo Bachoura, MDa, Andrew S. Deane, PhDb, James N. Clavicle morphometry revisited: a 3-dimensional study with relevance to operative fixation. J Shoulder Elbow Surg (2013) 22, e15-e21,功 能,增加上肢运动范围 稳定上肢结构 肌肉附着点,功 能,保护血管神经结构 增强呼吸 美人骨,Clavicle Fracture Broken Collarbone,手术 保守治疗,Clavicle Fracture Broken Collarbone,Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960 Mar 5;172 (10):1006-11 Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res 1968;58:29-42.,不愈合率： 保守 1% 手术 4%,Clavicle Fracture Broken Collarbone,Canadian OrthopaedicTrauma Society, 2007 RCT,不愈合率： 保守 11% 手术 3%,Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89(1):1-10,证据级别较低 8字绷带固定并不优于上肢悬吊 保守治疗畸形愈合和肩关节僵硬发生率高 手术治疗不能明显改善上肢功能 手术治疗没有明显改善愈合 髓内钉治疗结果没有明显优于钢板 钢板在骨折近端置于前侧、远端置于上方优于钢板完全置于上方 治疗选择个体化,手术明显降低不愈合率 ( 1% : 23%) 手术能改善上肢功能 长期功能改善不明确,Who should be fixed?,移位骨折不愈合率高 (26%) 钢板固定能明显降低不愈合率 钢板固定并发症低 手术能改善肢体功能,移 位,锁骨短缩 10%明显影响肩胛骨运动,Noboru Matsumura, Hiroyasu Ikegami, Noriaki Nakamichi. Effect of Shortening Deformity of the Clavicle on Scapular Kinematics: A Cadaveric Study.The American Journal of Sports Medicine;38(5):1000 DooSup Kim, DongWoo Lee, YoungHwan Jang,Effects of short malunion of the clavicle on in vivo scapular kinematics. J Shoulder Elbow Surg.2017,移 位,移位超过1个锁骨干宽度,手术能明显提高愈合率 手术与非手术上肢功能无明显差别,Woltz S, Stegeman SA, Krijnen P. Plate Fixation Compared with Nonoperative Treatment for Displaced Midshaft Clavicular Fractures: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am. 2017; 99(2):106-112. Robinson CM1, Goudie EB, Murray IR. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am. 2013;95(17):1576-84,Lori Anne Archer, Stephen Hunt, Daniel Squire. Plain film measurement error in acute displaced midshaft clavicle fractures. Can J Surg;59(5),311-316,手术指征,充分了解病人要求 个体化选择 运动爱好者,并发症,切口 感染 内固定 再骨折 畸形愈合,切 口,美观 麻木,切 口,美观 麻木,Dave R. Shukla, William J,Rubenstein BA. The Influence of Incision Type on Patient Satisfaction After Plate Fixation of Clavicle Fractures. The Orthopaedic Journal of Sports Medicine, 5(6),切 口,美观 麻木,Dave R. Shukla, William J,Rubenstein BA. The Influence of Incision Type on Patient Satisfaction After Plate Fixation of Clavicle Fractures. The Orthopaedic Journal of Sports Medicine, 5(6),血管神经损伤,A. Stillwella,Ioannoua, L. Danielea, S.L.E. Tana. Osteosynthesis for clavicle fractures