| Objective: To observe the clinical efficacy of double Endobutton plate internal fixation in the treatment of Neer type II distal clavicle fractures,and summarize the advantages and disadvantages of the treatment of clavicle hook plate fixation.Methods: A retrospective analysis of January 2012 to January 2016 in the Department of orthopedics,our hospital clinical data were complete in 60 cases of Neer type II distal clavicle fracture patients,according to different surgical methods,the whole Endobutto arthroscopic double plate fixation were divided into treatment group(30 cases),for clavicular hook plate fixation treatment as the control group(30 cases),since the date of admission to carry out follow-up records of patients with perioperative indicators(operation time,intraoperative bleeding volume,postoperative complications,hospitalization time and total cost),fracture healing time,postoperative complications and at different time points(1,3,6,12 months before and after the operation)DASH upper limb function score and ASES score,Constant-Murley score of shoulder joint function,the follow-up deadline in 2017 In January 31 st,the collected data were collected and analyzed with SPSS20.0 software package for statistical analysis.Results: 1.The research into group of 60 patients with satisfactory anesthesia,good fracture reduction,smooth operation,after operation in the two groups,2 cases of mild reaction to anesthesia(nausea,vomiting),two groups of patients with operation time,hospitalization of the total cost of close to(t=2.334(P<0.05).t=1.547,P>0.05);Treatment group of patients with intraoperative blood loss,hospitalization time was less than that of the control group(t=5.364(P<0.05).t=8.665,P<0.05).The shortest II patients enrolled in the study,all the patients were followed up for 12 months,the longest follow-up of 39 months,the median follow-up time was 22 months.The follow-up rate was 100%,fracture in(7-15)weeks clinical healing,treatment groups of patients with fracture healing time,from 7 to 14 weeks.(951±1.47)weeks on average;Control groups of patients with fracture healing time(8-15)weeks,the average(9.02±1.65)weeks,two groups of patients with fracture healing time difference was not statistically significant(t=1.846,P>0.05).Before the two groups of patients undergoing upper limb function DASH score close to(t=1.325,P>0.05).Compared with the preoperative,the treatment group and the control group of patients for 12 months after the dash upper limb function score improved significantly(t=15.354(P<0.05).t=12.424,P<0.05);Two groups of patients with postoperative 1,3,6,12 months dash upper limb function score differences had no statistical significance(t=2.046(P<0.05).t=1.881(P<0.05).t=1.554(P<0.05).t=1.624,P>0.05).The two groups of patients with preoperative ases score(t=1.485,P>0.05).Compared with the preoperative,the treatment group and the control group patients after 12 months of ases score improved significantly(t=14.278(P<0.05).t=16.225,P<0.05);Treatment group patients after 1 month and 3 months the ases score better than the control group(t=8.112(P<0.05).t=6.551,P<0.05);Two groups of patients with postoperative ases score 6 and 12 months,the differences were not statistically significant(t=1.629(P<0.05).t=1.334,P>0.05).Before the two groups of patients undergoing constant Murley shoulder joint function score were similar(P>0.05)t=2.334;Compared with the preoperative,the treatment group and the control group were treated after 12 months of constant Murley shoulder joint function score improved significantly(t=15.378(P<0.05).t=14.235,P<0.05);Treatment group patients after 1 month and 3 months of constant Murley shoulder joint function scores than the control group(t=9.557(P<0.05).t=11.357,P<0.05);Two groups of patients after 6 and 12 months of constant Murley shoulder joint function score differences were not statistically significant(t=1.524(P<0.05).t=1.842,P>0.05).Before the two groups of patients with shoulder pain scores close to(t=1.224,P>0.05).Compared with the preoperative,two groups of patients after 12 months after the shoulder joint pain significantly reduced(t=12.547(P<0.05).t=11.027,P<0.05);Treatment group patients after 1 month and 3 months of shoulder pain scores than the controls(t=8.624(P<0.05).t=7.559,P<0.05);Two groups of patients with postoperative 6 and 12 months of shoulder joint pain score(t=1.423(P<0.05).t=2.331,P>0.05).Seventhly,two groups of patients with preoperative range of motion of shoulder joint points close to(t=1.489,P>0.05);Compared with preoperative,two groups of patients after 12 months after the shoulder joint activity increased significantly(t=13.266(P<0.05).t=11.554,P<0.05);Treatment group patients after 1 month and 3 months of shoulder joint activity Fan Wai score than the control group(t=4.957(P<0.05).t=5.887,P<0.05);Two groups of patients after 6 and 12 months,the range of motion of shoulder joint score(t=2.116(P<0.05).t=1.659,P>0.05).The two groups of patients with preoperative power integral close(t=1.114,P>0.05).Compared with the preoperative,two groups of patients with postoperative 12 months after strength increased significantly(t=13.556(P<0.05).t=12.337,P<0.05);Two groups of patients after 1,3,6,12 months strength score(t=1.446(P<0.05).t=174.1(P<0.05).t=1.854(P<0.05).t=1.247,P>0.05).Anlyses two groups of patients with preoperative daily activities integrals approaching(t=1.364,P>0.05);Compared with the preoperative,two groups of patients after 12 months after daily activities increased significantly(t=16.246(P<0.05).t=12.147,P<0.05);Treatment group patients after 1 month and 3 months daily activity score than the control group(t=5.554(P<0.05).t=4.874,P<0.05);Two groups of patients with postoperative 6 and 12 months of daily activity score(t=2.569(P<0.05).t=1.529,P>0.05).Until follow-up to date,the treatment group appeared delayed healing in 1 cases;Control group,one case of delayed union,1 cases of screws loosening,1 cases of myositis ossificans,2 cases of shoulder pain.Delayed union and screw loosening were enhanced in the patients with external fixation and the end of the fixed time was healed.The other complications were relieved after symptomatic treatment.The incidence rate of complications in the treatment group was 3.33%,which was significantly lower than that of the control group(χ2=6.717,P<0.05)16.67%.Conclusion: Arthroscopic double Endobutto plate with clavicular hook plate internal fixation are effective ways of treatment of Neer type II distal clavicle fracture and all arthroscopic double Endobutto plate fixation has less trauma,less bleeding,less pain,minor complications,postoperative shoulder function and activity of daily life recovery fast,clinical can consider the application. |
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