中文摘要：

目的探讨关节镜下纽扣钢板固定术治疗不稳定锁骨远端骨折的临床疗效。方法回顾性分析17例不稳定锁骨远端骨折经关节镜下纽扣钢板固定术后临床结果。通过Constant评分,简明肩关节功能测试(simple shoulder text,SST),VAS疼痛评分对患者在最后一次随访时的肩关节功能进行评价。结果本组患者共17例,男性10例,女性7例。平均年龄42.6岁(27~68岁)。按照Robinson骨折分型,均为3B型。17例患者均获得随访,平均随访时间50个月(42~66个月)。16例患者骨折愈合,平均愈合时间3.2个月,1例骨折不愈合。术中发现合并关节内损伤2例,SLAP损伤1例,Bankart损伤1例,术中分别予以修复。患者术后Constant评分患侧平均93.1分(72~100分),健侧98.3分(90~100分)。SST患侧平均10.7分(8~12分),健侧11.6分(9~12分)。VAS评分患侧平均1.9分(0~4分),健侧1.7分(0~5分)。结论关节镜下纽扣钢板固定术具有临床效果良好,创伤小,可同时处理关节内合并损伤,喙锁弹性固定,不需要再次手术等优点。可以作为锁骨远端骨折治疗的一个选择。

英文摘要：

Background The cases of distal clavicular fracture account for 12%-1 5% of all clavicular fracture cases.Distal clavicular fracture combined with coracoclavicular ligament rupture frequently behave as unstable fracture,with the opportunity for fracture non-union in conservative therapy being as high as 21%.Although partial patients with fracture nonunion show mild clinical symptoms,the symptomatic nonunion may affect the functions of shoulder joint.Therefore,most of physicians suggest operative treatment for unstable distal clavicular fracture.The operative treatment can achieve fracture union rate up to 98%.The distal clavicular fracture is characterized by fracture combined with ligament injury, and there are also diversified clinical therapies. The frequently reported internal fixation methods include kirschner wire,tension band,coraco-clavicular screw, anchor,clavicular hook plate,anatomical locking plate as well as suture fixation,etc.After fracture union,the metallic internal implants are frequently required to be taken out through operation. Different therapies have both their advantages and disadvantages.At present,there has been no unified therapy for unstable distal clavicular fracture.Arthroscopic button plate fixation therapy for unstable distal clavicular fracture is a relatively new minimally invasive treatment method,and its technology is originated from arthroscopic button plate fixation for the treatment of dislocation of acromioclavicular joint.We made retrospective analysis on the clinical effects of arthroscopic button plate fixation on distal clavicular fracture and discussed the potential advantages and disadvantages of this therapy.Method Ⅰ.General materials:Twenty-one patients with unstable distal clavicular fracture who received operative treatment in our department during the period from September 2010 to December 2012 are collected,seventeen cases of these meet inclusion criteria,namely 10 male cases and 7 female cases,with an average age of 42.6 years;according to Robinson clavi