Comparison of the Efficacy of Hook Plate Versus Kirschner Wire in the Surgical Treatment of Unstable Fractures of the Distal Clavicle

不穩定性遠端鎖骨骨折使用鉤桿骨板或K氏骨釘之療效比較

黃建睿(Chien-Rae Huang) ； 李懿訓(Yih-Shiunn Lee)

《北市醫學雜誌》 2卷3期 (2005/03) Pp. 265-271

https://doi.org/10.6200/TCMJ.2005.2.3.05

摘要

目的：不穩定性遠端鎖骨骨折通常需要接受手術固定來獲得滿意的結果，傳統的手術方法使用K氏骨釘經常產生併發症。近兩年來，我們採用鎖骨骨鉤桿骨板來固定此種骨折，初步的結果令人滿意。這篇論文的目的，是比較這兩種手術方法的臨床結果。方法：收集1999至2002年10個在本院接受K氏骨釘固定的遠端鎖骨骨折的病患，以及2002至2004年8個接受鎖骨鉤桿骨板固定的病患，使用一個常用的肩關節的功能評分系統來評估臨床結果，再利用費歇爾精確檢定來分析病患的性別、身體狀況、併發症比率、植入物引起的症狀、回復到工作的能力等，以及使用Mann-Whitney U檢定來比較肩關節功能的統計得分。結果：在採用K氏骨釘這組的平均得分為80±5.3分，而採用鉤桿骨板這組則為94±4.8分（P值=005)，後者有明顯較低的植入物鬆脫比率（P值=0013）以及植入物造成症狀的情形（p值=0025）。除此之外，鉤桿骨板這組病患有較佳恢復工作能力（P值=0025）。結論：如果遠端鎖骨骨折的病患接受手術是必要的，採用鉤桿骨板比採用K氏骨釘的效果較佳。

關鍵字

遠端鎖骨骨折 ； K氏骨釘 ； 鉤桿骨板

並列摘要

Objectives: Unstable fractures of the distal clavicle usually require surgical fixation to achieve satisfactory results. The traditional method using Kirschner-wire (K-wire) fixation has always been adopted in the past. However, complications commonly occur. Over the last two years, we have adopted a claviclular hook plate fixation method to treat such cases and the preliminary results are highly satisfactory. The purpose of this study is to review the clinical outcomes of the to techniques. Patients and Methods: Between 1999 and 2002, ten unstable fractures of the distal clavicle were operated on using K-wire fixation at our institution. During 2002-2004, eight consecutive cases were treated by hook plate fixation. The clinical results were evaluated by a popular shoulder scoring system. The Fisher's exact test was used to analyze gender versus type, confounding medical conditions, complication rates, symptomatic hardware rates, elective hardware removal rates, and the ability to return to work. A Mann-Whitney U test was used to compare the shoulder scores. Results: The mean shoulder score for K-wire fixation was 80±5.3 points and for hook plate fixation was 94±4.8 points (p=0.05). Hook plating had a significantly lower rate of loss of reduction (p=0.013) and symptomatic hardware (p=0.025). In addition, hook plate fixation resulted in a higher rate of return to work (p=0.025). Conclusion: If surgery of distal clavicular fractures is indicated, internal fixation with a hook plate has distinct advantages over the K-wire method.

並列關鍵字

distal claviclular fracture ； Kirschner wire ； hook plate