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目的 探讨解剖锁定钢板治疗急性不稳定性锁骨远端骨折的临床疗效.方法 本研究回顾性分析自 2012 年 10 月至 2015 年 10 月,本院收治的急性不稳定性锁骨远端骨折患者的临床资料.本组共32 例,其中男 24 例,女 8 例,平均年龄 45.7 ( 21~66 ) 岁.平均随访时间 18.8 ( 14~36 ) 个月.平均受伤到手术时间 3.2 ( 1~15 ) 天.平均手术时间 97.8 ( 60~135 ) min,术中出血量 42.2 ( 20~100 ) ml.选用国产钢板治疗 18 例,Peri-loc 钢板 14 例.平均骨愈合时间 14.5 ( 8~20 ) 周.采用配对 Student-t 检验比较喙锁距离和末次随访时肩关节功能评分 ( Constant、UCLA 评分 ) 差异.结果 锁骨远端骨折块距肩锁关节的最近骨折线平均为 22.4 ( 15~32 ) mm,伤后平均 3.2 ( 1~15 ) 天接受解剖锁定钢板固定,其中 6 例附加骨折块间固定,2 例喙锁韧带强化,2 例异体骨植骨,骨愈合时间平均为 14.5 ( 8~20 ) 周,未观察到主要并发症.术前和末次随访时患侧的喙锁距离增加率 ( coracoclavicular ratio,CCR ) 差异有统计学意义 ( P=0.008 ),末次随访时患侧和健侧 CCR 差异无统计学意义 ( P=0.175 );末次随访患侧肩关节 Constant 评分为 91 ( 86~95 ) 分,UCLA 评分为30 ( 26~32 ) 分,与健侧相比差异无统计学意义 ( P=0.13 ).结论 锁骨远端解剖锁定钢板具有生物力学优势,对>20 mm 的远端骨折块可提供可靠的稳定结构且同期联合骨折块间固定和 ( 或 ) 喙锁韧带强化,最大程度避免潜在的内植物失效等主要并发症,是治疗急性不稳定性锁骨远端骨折的一种可行的治疗方案.“,”Objective To evaluate clinical and radiographic outcomes of the treatment using anatomic locking plate ( ALP ) for acute unstable distal clavicular fractures, and to introduce technique strategy. Methods In this retrospective study, 32 patients ( 24 males and 8 females ) were collected from October 2012 to October 2015 with an average age of 45.7 years ( range: 21 - 66 years ). The mean follow-up was 18.8 months ( range: 14 - 36 months ). The average time to injury was 3.2 days ( range: 1 - 15 days ). The average operation time: 97.8 min ( range: 60 - 135 min ). Intraoperative bleeding: 42.2 ml ( range: 20 - 100 ml ). Eighteen patients were treated with domestic plate and 14 cases with Peri-loc plate. The mean bone healing time was 14.5 weeks ( range: 8 - 20 weeks ). Results of Constant-Murley Shoulder Outcome Score ( Constant score ) and University of California, Los Angeles shoulder rating scale ( UCLA ) as well as radiographic data coracoclavicular ratio ( CCR ) were recorded. Functional scores and CCR were compared between the affected and contralateral side by paired Student-t test. Results The mean fracture line from AC joint was 22.4 mm ( range: 15 - 32 mm ). After an average of 3.2 days ( range: 1 - 15 days ) following the injury, anatomical locking plate fixation was performed. Six patients were performed with additional interfragmentary fixation, 2 with coracoclacicular loop-and-sling technique using suture 5#, 2 with bone allograft during open reduction and ALP fixation. The mean bone union time was 14.5 weeks ( range: 8 - 20 weeks ). No major complications were observed. The CCR of the affected side after operation was statistically and significantly decreased compared with pre-operation ( P = 0.008 ), while no significant differences were found in the latest follow-up ( P = 0.175 ). The mean Constance score of the injured side: 91 ( range: 86 - 95 ); UCLA: 30 ( range: 26 - 32 ); no statistically significant differences compared with the contralateral side ( P = 0.13, 0.238 respectively ). Conclusions ALPs have some biomechanical advantages and can provide enough stability in the distal fragment ( size > 20 mm from AC joint ), which can be augmented with coracoclacicular sutures and / or intrafragmentary fixation or bone graft simultaneously to avoid potential complications of implant failure. It is applicable in the treatment of acute unstable distal clavicular fractures.