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目的 探讨喙锁韧带重建结合钢板固定治疗伴喙锁韧带锁骨止点撕脱的锁骨远端骨折的疗效.方法 回顾性分析2013年1月至2018年12月采用喙锁韧带重建结合钢板固定治疗17例伴喙锁韧带止点撕脱的锁骨远端骨折患者资料.根据术中是否重建喙锁韧带分为未重建组和重建组:未重建组10例,男7例,女3例;年龄(37.9±11.9)岁(范围,19～60岁).重建组7例,男5例,女2例;年龄(44.9±13.0)岁(范围,25～62岁).术前采用三维CT检查判断韧带损伤并据此分组.术后比较两组患者的骨折愈合时间、视觉模拟评分(visual analogue scale,VAS)、肩关节Constant-Murley评分、肩关节功能优良率及总体并发症发生率.结果 两组患者均获得随访,随访时间(18.7±6.7)个月(范围,9～27个月).两组患者锁骨骨折均愈合,重建组骨折愈合时间(12.6±0.7)周(范围,12～14周),未重建组(23.7±7.9)周(范围,16～48周),两组比较差异有统计学意义(t=3.361,P=0.004).末次随访时,重建组VAS评分[(3.0±1.3)分]、Constant-Murley评分[(85±11)分]分别与未重建组[(3.1±1.8)分、(77±10)分]比较,差异均无统计学意义(P＞0.05).末次随访时,未重建组发生骨折延迟愈合(术后48周)1例,锁骨钩钢板松动1例,内固定取出后再发肩锁关节脱位(Rockwood分型Ⅱ度)5例,并发症发生率为70％(7/10);重建组发生肩峰骨折1例,并发症发生率为14.3％(1/7);两组比较差异有统计学意义(x2=5.13,P=0.024).结论 重建喙锁韧带锁骨止点可有效降低伴喙锁韧带锁骨止点撕脱的锁骨远端骨折术后并发症,术后疗效满意.“,”Objective To explore the operative strategy of distal clavicle fracture involving coracoclavicular ligament.Methods Data of 17 cases of distal clavicle fracture involving coracoclavicular ligament in our hospital from January 2013 to December 2018 were analyzed retrospectively.According to whether the coracoclavicular ligament was reconstructed or not,the patients were divided into two groups:non reconstruction group (10 cases),male (7 cases),female (3 cases),19-60 years old (37.9± 11.9).In the reconstruction group,7 cases were male 5,female 2,25-62 years old (44.9± 13.0).Three dimensional CT was used to judge the ligament injury and X-ray was used to evaluate the fracture reduction and healing after operation.The time of fracture healing was compared between the two groups.The function of shoulder joint was evaluated by visual analog scale (VAS) and Constant score of shoulder joint.Results The patients in both groups were followed up for (18.7±6.7) months (range,9-27 months).At the latest follow-up,the time of fracture healing in the reconstruction group was 12.6±0.7 weeks (range,12-14 weeks);VAS score was 3.0± 1.3 and Constant-Murley score was 85± 11.While those in the non reconstruction group were 23.7±7.9 (range,16-48 weeks),3.1± 1.8 and 77± 10 respectively.The time of fracture healing was statistically significant (t=3.361,P=0.004).There was no significant difference in VAS score and Constant score (P＞ 0.05).In the non reconstruction group,there were 1 case of delayed union of fracture (healed 48 weeks after operation),1 case of loosening of clavicular hook plate,5 cases of acromioclavicular joint dislocation (Rockwood type Ⅱ) after removal of internal fixation,and the overall complication rate was 70％ (7/10).Reconstruction group:1 case of acromial fracture,the overall complication rate was 14.3％ (1/7).There was significant difference between the two groups (x2=5.13,P=0.024).Conclusion Reconstruction of clavicular insertion of coracoclavicular ligament can effectively reduce the postoperative complications of distal clavicular fracture involving the coracoclavicular insertion.Attention should be paid to the repair and reconstruction of coracoclavicular ligament injury during fracture treatment.