切换至 "中华医学电子期刊资源库"

中华肩肘外科电子杂志 ›› 2022, Vol. 10 ›› Issue (03) : 271 -274. doi: 10.3877/cma.j.issn.2095-5790.2022.03.014

病例报告

数字规划、3D打印、个体化锁骨钩钢板治疗锁骨远端骨折一例
陈健1, 张庆1, 左才红1, 李军1, 黄照国1, 陶忠亮1, 陈纯纯1, 陈建海2,()   
  1. 1. 242000 宣城市人民医院骨科
    2. 100044 北京大学人民医院创伤骨科
  • 收稿日期:2021-07-26 出版日期:2022-08-05
  • 通信作者: 陈建海
  • 基金资助:
    安徽省重点研究与开发计划项目(202104j07020007)
  • Received:2021-07-26 Published:2022-08-05
引用本文:

陈健, 张庆, 左才红, 李军, 黄照国, 陶忠亮, 陈纯纯, 陈建海. 数字规划、3D打印、个体化锁骨钩钢板治疗锁骨远端骨折一例[J]. 中华肩肘外科电子杂志, 2022, 10(03): 271-274.

锁骨远端骨折占所有锁骨骨折的12%~25%[1]。Neer[2]将锁骨远端骨折分为3种类型,无移位的锁骨远端骨折(Type I)、有移位的锁骨远端骨折(Type II)、锁骨远端关节内骨折(Type III)。锁骨远端移位性骨折较锁骨中段骨折少见,但非手术治疗后发生骨不连和骨畸形愈合的风险相对较高,且功能预后较差[3],肩部可能会出现持续性疼痛、活动受限和失去力量及耐力[4]。因此,对于身体健康的患者,通常推荐手术治疗。对于移位锁骨远端骨折的手术技术多种多样,这些技术主要包括:(1)喙锁螺钉固定[5];(2)锁骨远端锁定接骨板固定[6];(3)钩钢板固定[7];(4)Endobutton固定[4];(5)TightRope固定[8];(6)切开复位隧道悬吊器械/装置固定[9]等,每种固定技术的优势比较仍有争议。锁骨钩钢板因其具有解剖复位骨折和坚强内固定优点而广泛运用于临床,并取得了良好的结果[7]。然而,文献显示钩钢板内固定后存在一定的并发症,如肩锁关节炎、肩峰撞击综合征、肩峰骨溶解[10],主要原因锁骨钩钢板形态同肩峰形态不匹配[11,12]

图1 患者女性,50岁,跌倒致左锁骨远端骨折(Neer II型,Edinburgh 3B型)
图2 将患者左侧锁骨远端CT数据导入Mimics 17.0软件,通过阈值分割、区域增长,建立左侧锁骨远端三维几何模型 图A:正面观;图B:上面观
图3 计算机复位左锁骨远端骨折 图A:正面观;图B:上面观
图4 3D打印复位后左锁骨远端,未塑形的锁骨钩钢板匹配左肩锁关节 图A:正面观;图B:上面观;图C:锁骨钩钢板近端同锁骨远端匹配,而锁骨钩在肩峰外
图5 塑形后锁骨钩钢板匹配左肩锁关节 图A:正面观;图B:上面观
图6 锁骨钩钢板塑形前、后照片 图A:塑形后;图B:塑形前
图7 X线片影像 图A:术中影像;图B:术后影像
图8 术后6个月影像 图A:X线片影像;图B-D:CT影像
图9 术后6个月随访功能照片,Constant肩关节评分96分,ASES肩关节评分95分,UCLA肩关节评分33分 图A:外展上举;图B:前屈上举;图C:后伸;图D:内旋;图E:外旋
[1]
van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review[J] . J Shoulder Elbow Surg,201221(3):423-429.
[2]
Neer CS II. Fractures of the distal third of the clavicle[J] . Clin Orthop Relat Res, 1968,58:43-50.
[3]
Robinson CM, Bell KR, Murray IR. Open Reduction and Tunneled Suspensory Device Fixation of Displaced Lateral-End Clavicular Fractures: Medium-Term Outcomes and Complications After Treatment [J] . J Bone Joint Surg Am,2019, 101(15):1335-1341.
[4]
Robinson CM, Akhtar MA, Jenkins PJ, et al. Open reduction and endobutton fixation of displaced fractures of the lateral end of the clavicle in younger patients[J] . J Bone Joint Surg Br, 2010,92(6):811-816.
[5]
Esenyel CZ, Ceylan HH, Ayanoglu SA, et al. Treatment of neer type 2 fractures of the distal clavicle with coracoclavicular screw[J].Acta Orthop Traumatol Turc, 2011, 45(5): 291- 296.
[6]
Erdle B, Izadpanah K, Jaeger M, et al. Comparative analysis of locking plate versus hook plate osteosynthesis of Neer type IIB lateral clavicle fractures[J] . Arch Orthop Trauma Surg,2017,137(5):651-662.
[7]
Good DW, Lui DF, Leonard M, et al. Clavicle hook plate fixation for displaced lateral-third clavicle fractures (Neer type II): a functional outcome study[J] . J Shoulder Elbow Surg, 2012,21(8):1045-1048.
[8]
Cho CH, Jung JH, Kim BS. Coracoclavicular stabilization using a suture button device for Neer type IIB lateral clavicle fractures[J]. J Shoulder Elbow Surg,2017,26(5):804-808.
[9]
Robinson CM, Bell KR, Murray IR. Open Reduction and Tunneled Suspensory Device Fixation of Displaced Lateral-End Clavicular Fractures: Medium-Term Outcomes and Complications After Treatment[J] . J Bone Joint Surg Am, 2019,101(15):1335-1341.
[10]
Tiren D, van Bemmel AJ, Swank DJ, et al. Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview[J] . J Orthop Surg Res, 2012, 7:2.
[11]
Gu X, Cheng B, Sun J, et al. Arthroscopic evaluation for omalgia patients undergoing the clavicular hook plate fixation of distal clavicle fractures[J] . J Orthop Surg Res, 2014, 9: 46.
[12]
Yoon JP, Lee YS, Song GS, et al. Morphological analysis of acromion and hook plate for the fixation of acromioclavicular joint dislocation[J] . Knee Surg Sports Traumatol Arthrosc, 2017 ,25(3):980-986.
[13]
Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification[J] . J Bone Joint Surg Br,1998, 80(3):476-484.
[14]
Postacchini F, Gumina S, De Santis P, et al. Epidemiology of clavicle fractures[J] . J Shoulder Elbow Surg, 2002,11(5):452-456.
[15]
Oh JH, Kim SH, Lee JH, et al. Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures[J] . Arch Orthop Trauma Surg, 2011, 131(4):525-533.
[16]
Jupiter JB, Leffert RD. Non-union of the clavicle. Associated complications and surgical management[J] . J Bone Joint Surg Am,1987,69(5):753-760.
[17]
Eschler A, Gradl G, Gierer P, et al. Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation, however presents with a high rate of acromial osteolysis[J] . Arch Orthop Trauma Surg,2011, 132(1):33-39.
[18]
Ryhänen J, Niemelä E, Kaarela O, et al. Stabilization of acute, complete acromioclavicular joint dislocations with a new C hook implant[J] . J Shoulder Elbow Surg,2003,12(5):442-445.
[19]
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[J] . Orthop Traumatol Surg Res,2020,106(1):67-75.
[20]
吴晓明,高伟,李凡,等.锁骨钩钢板内固定术后并发症分析与防治对策[J] .中华骨科杂志,2012(4):331-338.
[21]
Singh A, Schultzel M, Fleming JF, et al. Complications after surgical treatment of distal clavicle fractures[J] . Orthop Traumatol Surg Res, 2019,105(5):853-859.
[22]
Klein SM, Badman BL, Keating CJ, et al. Results of surgical treatment for unstable distal clavicular fractures[J] . J Shoulder Elbow Surg, 2010,19(7):1049-1055.
[23]
Yoon JP, Lee YS, Song GS, et al. Morphological analysis of acromion and hook plate for the fixation of acromioclavicular joint dislocation[J] .Knee Surg Sports Traumatol Arthrosc, 2017 ,25(3):980-986.
[24]
ElMaraghy AW, Devereaux MW, Ravichandiran K, et al. Subacromial morphometric assessment of the clavicle hook plate[J]. Injury,2010,41(6):613-619.
[25]
Hsu CL, Chou YC, Li YT, et al. Pre-operative virtual simulation and three-dimensional printing techniques for the surgical management of acetabular fractures[J] . Int Orthop,2019, 43(8):1969-1976.
[26]
Hung CC, Li YT, Chou YC, et al. Conventional plate fixation method versus pre-operative virtual simulation and three-dimensional printing-assisted contoured plate fixation method in the treatment of anterior pelvic ring fracture[J] . Int Orthop, 2019,43(2):425-431.
[27]
Xie L, Chen C, Zhang Y, et al. Three-dimensional printing assisted ORIF versus conventional ORIF for tibial plateau fractures: A systematic review and meta-analysis[J] . Int J Surg,2018,57:35-44.
No related articles found!
阅读次数
全文


摘要