| Objective: The middle fracture of clavicle is the most common kind ofclavicle fracture. There are many kinds of methods to fix the clavicle fracture,for example, intramedullary nail, memory alloy clavicle encirclement, wire,and reconstructed plate fixation which is the most common, however, notconvenient in clinical application. Obscured by patient’s neck and head, screwplacement is very inconvenient when plate fixation is done proximal above theclavicle.Through clinical practice and deep analysis of clavicular anatomy, wedesigned a new clavicular anatomical plates characterized by fixing theproximal clavicle to the front side and the distal to the above. With thisimproved structure, clavicle was three-dimensional fixed by plates.Advantages were:①Surgical procedure was simple, and less periostealstripping contributed to blood supply and healing of fracture;②Three-dimensional fixation was more reliable;③The fixation avoided injuryof subclavian vessels and brachial plexus;④Combination of fracture fixationand biomechanics did good to the recovery of limb function with highersecurity;⑤Operation was more advantaged. We tried to analyze thefeasibility and practicability of the3D anatomical plates by further anatomicalresearch.Methods：（1） The eight adult anticorrosive corpses taken the15complete subclavian specimens of. All the bodies collarbone fracture, norclavicle or shoulder surgery history. Samples were lying body in anatomicalunits, skin and subcutaneous tissue are removed, fully exposed muscle andclavicle, exposed to the sternoclavicular joint and acromioclavicular joint. Thespecimens were randomly divided into three groups A, B, C. Clavicularmidpoint group A lock on a steel plate set group; B group for the locking plate front group, after shaping in line with the front outline general locking plategroup A the same fixed principles, fixed in the clavicle the front side. Lockingplate fixation group C group is three-dimensional: homemade3D collarbonelocking plate, this plate without shaping or after a simple shaping plate1/2segment in the clavicle front,1/2of the outer steel plate located above theclavicle, each side of the same four pairs of cortical screws wereimplanted.Select each specimen proximal the five screws penetrate thecontralateral cortex point, respectively measuring each distance brachialplexus, subclavian artery, subclavian vein distance, for statistical analysis,statistical three sets of steel plates fixed to surgery to avoid collarbonethesignificance of the next important nerves and blood vessels for clinical trials,medical statistics of all data software MedCalc11.2statistical processingstatistics, T-test, the three-dimensional fixation plate with the first two fixedprogram whether the differences, P <0.05significant differences.（2） Having excluded abnormal conditions such as osteoporosis, tumor,deformity, injury, there were15clavicles of adult cadaver specimens in total.We made a bone defect in the diameter of5mm on the same position in themiddle of all clavicles by bone saw.15clavicles were divided into threegroups randomly. Group A was to fix the plate above the clavicle; Group Bwas to fix the plate in front of clavicle; Group C used the three-dimensionalfixed plate without shaping or with a little. Guaranteeing that there were atleast three screw holes and three bicortical screws implanted on each side, theinner half of3D plate was located in front of clavicle in subterminal fracture,and the outer was above clavicle in distal fracture. Each specimen was fixedon the homemade fixture with denture powder. We placed them in abiomechanical machine to test each specimen by three-point bending test,torsion test in turn. Analysis of statistical datum had significant differencewhen P <0.05.Results：(1)Anatomical measurement results:Compare three sets of steelplate internal fixation from the brachial plexus, three-dimensional steel platefixation group compared with overhead steel plate fixation group, distal holes 1,2, no obvious difference from the brachial plexus (P>0.05), the near sidethree-dimensional fixation group in clavicle fixed side before,3,4,5holecomparative difference was statistically significant (P <0.05),three-dimensional steel measurement distance large steel plate fixation group,to stay away from the brachial plexus, safer. Three-dimensional steel platefixation group compared with the front steel plate fixation group: the distalhole1comparative difference was statistically significant (P <0.05), the frontsteel plate fixation group measured a greater distance.2,3,4,5hole is noobvious difference (P>0.05).Three sets of steel plate internal fixation distance subclavian artery:three-dimensional steel plate fixation group compared with overhead steelplate fixation group, the distal holes1,2,3, is apart from the subclavian arteryis no obvious difference (P>0.05).4,5hole difference was statisticallysignificant (P <0.05), three-dimensional steel plate fixation group measureddistance is larger, can stay away from the subclavian artery. Three-dimensionalsteel plate fixation group compared with the front steel plate fixation group:distal holes1,2, the difference was statistically significant (P <0.05), the frontsteel plate fixation group more security than three-dimensional plate fixation.3,4,5hole is no obvious difference (P>0.05), and the proximal side beforeusing fixed effect had no significant difference.Subclavian vein to compare three sets of steel plate internal fixationdistance: three-dimensional steel plate fixation group compared with overheadsteel plate fixation group,1distal hole is apart from the subclavian vein is noobvious difference (P>0.05), compared to2,3,4,5hole difference wasstatistically significant (P <0.05), the three-dimensional steel plate fixationgroup measured distance is larger, farther from the subclavian vein.Three-dimensional steel plate fixation group compared with the front steelplate fixation group1,2holes on front plate fixation is superior to the3dplate fixation group,3,4,5hole is no obvious difference (P>0.05), fixedposition is the same, no statistical significance.As can be seen using three-dimensional fixation group and treating clavicular fracture fixation group can clearly of the side away from importantnerve blood vessels.(2)Biomechanical results:①In three-point bending test, there was a linear relationship betweendisplacement and load pressure in three positions under the loading pressure ata range of10N-80N, i.e., displacement increased gradually with the increaseof loading pressure. Displacements were different in different fixed positionsunder the maximum load pressure80N. Statistical results: Group A was thebest, and Group B was the worst.②In positive torsion test, there was a linearrelationship between torque and angle in three positions at the rotation angle ata range of0-10°, i.e., torque increased with the increase of twist angle.Statistical results: Group C was the best.③In negative torsion test, there was alinear relationship between torque and angle in three positions at the rotationangle at a range of0-10°, i.e., torque increased with the increase of twist angle.Statistical results: Group C was the best.Conclusions: Through MRI imaging research to the safe depth and angleof drilling in clavicle plate fixation and combination of operating experienceand biomechanical experiments, the three-dimensional fixed plate for claviclewe designed had following advantages:①Surgical procedure was simple, andless periosteal stripping contributed to blood supply and healing of fracture;③The fixation avoided the injury of subclavian vessels and brachial plexus;④Combination of fracture fixation and biomechanics did good to the recovery oflimb function with higher security. |
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