临床小儿外科杂志

引言
1 讨论

图1 生后第3天X线片显示右侧锁骨于中间断离两部分,断端错位,断端高于锁骨水平;图2生后第38天锁骨正位X线片显示右锁骨中段断裂,断端圆钝﹑移位,且高于锁骨水平;图3患儿2岁6个月时锁骨正位X线片显示右锁骨从中间分离成左右两部分,断端边缘光滑整齐,可见硬化边。 <br/>Fig.1 The plain radiogragh at 3 days after brith showed a broken in the middle of the affected clavicle.The fragments were higher than the level of the clavicle;Fig.2 The plain radiogragh at 38 days after brith showed a broken in the middle of the affected clavicle.The fragments were round,displaced,and higher than the clavicle;Fig.3 The plain radiogragh at 30 months old showed the affected clavicle was divided into two fragments.The sclerotic rims were seen at the margins of the fragments。

图1 生后第3天X线片显示右侧锁骨于中间断离两部分,断端错位,断端高于锁骨水平;图2生后第38天锁骨正位X线片显示右锁骨中段断裂,断端圆钝﹑移位,且高于锁骨水平;图3患儿2岁6个月时锁骨正位X线片显示右锁骨从中间分离成左右两部分,断端边缘光滑整齐,可见硬化边。
Fig.1 The plain radiogragh at 3 days after brith showed a broken in the middle of the affected clavicle.The fragments were higher than the level of the clavicle;Fig.2 The plain radiogragh at 38 days after brith showed a broken in the middle of the affected clavicle.The fragments were round,displaced,and higher than the clavicle;Fig.3 The plain radiogragh at 30 months old showed the affected clavicle was divided into two fragments.The sclerotic rims were seen at the margins of the fragments。

图4 术前外观相:右锁骨中段包块,质硬,无活动,无压痛,局部表皮正常; 图5 术前锁骨正位片显示右锁骨中段骨质中断、明显分离,断端圆钝;图6 术前三维CT表现。A:三维重建显示右锁骨中段骨质不连续,断端分离移位。B:水平位显示右锁骨中段不连续,断端分离移位,断端之间见软组织密度影。
Fig.4 Preoperative appearance.A hard fixed mass can be found in the middle of clavicle.there was no tenderness,and the local skin was normal;Fig.5 The preoperative anteroposterior view radiogragh of the clavicle showed a broken and separated clavicle with round rims;Fig.6 Preoperative appreance of three dimensional Computed Tomography(CT)of clavicle.A:there was a discontinuous and displaced clavicle.B:Horizontal scans showed a discontinuous and displaced clavicle with soft tissue interposiotion.

图7 术前MRI平扫。A:冠状位T2加权显示右锁骨中段骨质不连续,断端分离移位,断端存在纤维组织连接,见混杂信号影。B:水平位T1加权显示右锁骨中段骨质不连续,断端分离移位,其间存在纤维组织连接,假关节胸骨端高于肩峰端。C:水平位T1加权提示锁骨胸骨端细小。<br/>Fig.7 The preoperative Magnetic Resonance Imaging(MRI)scans of clavicle.A:The coronary scans of T2 weighted showed a discontinuous and displaced clavicle with fiberous tissue interposition.B:The coronary scans of T1 weighted showed a discontinuous and displaced clavicle with fiberous tissue interposition.The sternal end of congenital pseudarthrosis of the clavicle was higher than the acromion end of that.C:The coronary scans of T1 weighted showed the sternal end of clavicle was thinner and smaller than the acromion end of clavicle.

图7 术前MRI平扫。A:冠状位T2加权显示右锁骨中段骨质不连续,断端分离移位,断端存在纤维组织连接,见混杂信号影。B:水平位T1加权显示右锁骨中段骨质不连续,断端分离移位,其间存在纤维组织连接,假关节胸骨端高于肩峰端。C:水平位T1加权提示锁骨胸骨端细小。
Fig.7 The preoperative Magnetic Resonance Imaging(MRI)scans of clavicle.A:The coronary scans of T2 weighted showed a discontinuous and displaced clavicle with fiberous tissue interposition.B:The coronary scans of T1 weighted showed a discontinuous and displaced clavicle with fiberous tissue interposition.The sternal end of congenital pseudarthrosis of the clavicle was higher than the acromion end of that.C:The coronary scans of T1 weighted showed the sternal end of clavicle was thinner and smaller than the acromion end of clavicle.

图8 术中髂骨植骨; 图9术中C臂透视显示克氏针固定良好; 图 10术后12个月X线片提示右锁骨假关节骨性愈合。<br/>Fig.8 Iliac bone grafting in the surgery; Fig.9 The intraoperative image intensifier showed the iliac bone graft and two parts of clavicle were fixed by a kirschner wire; Fig.10 The plain radiogragh of clavicle at 12 months postoperatively showed bony healing of pseudarthrosis.

图8 术中髂骨植骨; 图9术中C臂透视显示克氏针固定良好; 图 10术后12个月X线片提示右锁骨假关节骨性愈合。
Fig.8 Iliac bone grafting in the surgery; Fig.9 The intraoperative image intensifier showed the iliac bone graft and two parts of clavicle were fixed by a kirschner wire; Fig.10 The plain radiogragh of clavicle at 12 months postoperatively showed bony healing of pseudarthrosis.

1 Sung TH,Man EM,Chan AT,et al.Congenital pseudarthrosis of the clavicle:a rare and challenging diagnosis [J].Hong Kong Med J,2013,19(3):265 — 267.DOI:10.12809/hkmj133648.
2 Galanopoulos I,Ashwood N,Garlapati AK,et al.Congenital pseudarthrosis of clavicle:illustrated operative technique and histological findings [J].BMJ Case Rep,2012,DOI:10.1136/bcr — 2012 — 006908.
3 Watson HI,Hopper GP,Kovacs P.Congenital pseudarthrosis of the clavicle causing thoracic outlet syndrome [J].BMJ Case Rep,2013,2013.pii:bcr2013010437.DOI:10.1136/bcr — 2013 — 010437.
4 Elliot RR,Richards RH.Failed operative treatment in two cases of pseudarthrosis of the clavicle using internal fixation and bovine cancellous xenograft(Tutobone)[J].J Pediatr Orthop B,2011,20(5):349 — 353.DOI:10.1097/BPB.0b013e328346c010.
5 Currarino G,Herring JA.Congenital pseudarthrosis of the clavicle [J].Pediatr Radiol,2009,39(12):1343 — 1349.DOI:10.1007/s00247 — 009 — 1396 — 1.
6 Di Gennaro GL,Cravino M,Martinelli A,et al.Congenital pseudarthrosis of the clavicle:a report on 27 cases [J].J Shoulder Elbow Surg,2017,26(3):e65 — e70.DOI:10.1016/j.jse.2016.09.020.
7 Studer K,Baker MP,Krieg AH.Operative treatment of congenital pseudarthrosis of the clavicle:a single-centre experience [J].J Pediatr Orthop B,2017,26(3):245 — 249.DOI:10.1097/BPB.0000000000000400.
8 Chandran P,George H,James LA.Congenital clavicular pseudarthrosis:comparison of two treatment methods [J].J Child Orthop,2011,5(1):1 — 4.DOI:10.1007/s11832 — 010 — 0313 — 3.
9 Figueiredo MJ,Dos Reis Braga S,Akkari M,et al.Congenital pseudarthrosis of the clavicle [J].Rev Bras Ortop,2015,47(1):21 — 26.DOI:10.1016/S2255 — 4971(15)30341 — 4.
10 Persiani P,Molayem I,Villani C,et al. Surgical treatment of congenital pseudarthrosis of the clavicle:a report on 17 cases [J].Acta Orthop Belg,2008,74(2):161 — 166.
11 Gomez-Brouchet A,Sales de Gauzy J,Accadbled F,et al.Congenital pseudarthrosis of the clavicle:a histopathological study in five patients [J].J Pediatr Orthop B,2004,13(6):399 — 401.
12 Ettl V,Wild A,Krauspe R,et al.Surgical treatment of congenital pseudarthrosis of the clavicle:a report of three cases and review of the literature [J].Eur J Pediatr Surg,2005,15(1):56 — 60.DOI:10.1055/s — 2004 — 817944.
13 Sales de Gauzy J,Baunin C,Puget C,et al.Congenital pseudarthrosis of the clavicle and thoracic outlet syndrome in adolescence [J].J Pediatr Orthop B,1999,8(4):299 — 301.
14 Sakkers RJ,Tjin a Ton E,Bos CF.Left-sided congenital pseudarthrosis of the clavicula [J].J Pediatr Orthop B,1999,8(1):45 — 47.
15 Schnall SB,King JD,Marrero G.Congenital pseudarthrosis of the clavicle:a review of the literature and surgical results of six cases [J].J Pediatr Orthop,1988,8(3):316 — 321.
16 Quinlan WR,Brady PG,Regan BF.Congenital pseudarthrosis of the clavicle [J].Acta Orthop Scand,1980,51(3):489 — 492.
17 Manashil G,Laufer S.Congenital pseudarthrosis of the clavicle:report of three cases [J].AJR Am J Roentgenol,1979,132(4):678 — 679.DOI:10.2214/ajr.132.4.678.
18 温树正,郭文通,李文琪,等.先天性锁骨假关节 1 例报告[J].内蒙古医学院学报,1997,19(4):25.DOI:10.16343/j.cnki.issn.2095 — 512x.1997.04.010.
19 Glotzbecker MP,Shin EK,Chen NC,et al.Salvage reconstruction of congenital pseudarthrosis of the clavicle with vascularized fibular graft after failed operative treatment:a case report [J].J Pediatr Orthop,2009,29(4):411 — 415.DOI:10.1097/BPO.0b013e3181a5ebff.
20 Brévaut-Malaty V,Guillaume JM.Neonatal diagnosis of congenital pseudarthrosis of the clavicle [J].Pediatr Radiol,2009,39(12):1376.DOI:10.1007/s00247 — 009 — 1424 — 1.
21 Cataldo F.A 7-month-old child with a clavicular swelling since birth.Diagnosis:congenital pseudarthrosis of the clavicle [J].Eur J Pediatr,1999,158(12):1001 — 1002.
22 Grogan DP,Love SM,Guidera KJ,et al.Operative treatment of congenital pseudarthrosis of the clavicle [J].J Pediatr Orthop,1991,11(2):176 — 180.
23 O'Leary E,Elsayed S,Mukherjee A,et al.Familial pseudarthrosis of the clavicle:does it need treatment ? [J].Acta Orthop Belg,2008,74(4):437 — 440.
24 Sforza G,Levy O.Posttraumatic locked dislocation of congenital pseudarthrosis of the clavicle[J].J Shoulder Elbow Surg,2005,14(3):336 — 337.DOI:10.1016/j.jse.2004.06.017.
25 Russo MT,Maffulli N.Bilateral congenital pseudarthrosis of the clavicle [J].Arch Orthop Trauma Surg,1990,109(3):177 — 178.
26 Morin LR,Fossey FP,Besselièvre A,et al.Congenital pseu-darthrosis of the clavicle[J].Acta Obstet Gynecol Scand,1993,72(2):120 — 121.
27 Nieto Gil A,Gómez Navalón A,Zorrilla Ribot P.Bilateral congenital seudarthrosis of the clavicle [J].A clinical case,Rev Esp Cir Ortop Traumatol,2016,60(6):397 — 399.DOI:10.1016/j.recot.2015.02.004.
28 Karakurt L,Yilmaz E,Belhan O,et al.Pycnodysostosis associated with bilateral congenital pseudarthrosis of the clavicle [J].Arch Ortho Trauma Surg,2003,123(2 — 3):125 — 127.DOI:10.1007/s00402 — 003 — 0484 — 1.
29 Lorente Molto FJ,Bonete Lluch DJ,Garrido IM.Congenital pseudarthrosis of the clavicle:a proposal for early surgical treatment [J].J Pediatr Orthop,2001,21(5):689 — 693.
30 Hirata S,Miya H,Mizuno K.Congenital pseudarthrosis of the clavicle.Histologic examination for the etiology of the disease [J].Clin Orthop Relat Res,1995,(315):242 — 245.
31 Ogata S,Uhthoff HK.The early development and ossification of the human clavicle-an embryologic study [J].Acta Orthop Scand,1990,61(4):330 — 334.
32 Gibson DA,Carroll N.Congenital pseudoarthrosis of the clavicle [J].J Bone Joint Surg,1970,52(4):644 — 652.
33 Shalom A,Khermosh O,Wientroub S.The natural history of congenital pseudarthrosis of the clavicle [J].J Bone Joint Surg Br,1994,76(5):846 — 847.
34 Heidt C,Ziebarth K,Erni D,et al.Four years follow-up after clavicle reconstruction in a child:a case report [J].Plast Reconstr Aesthet Surg,2014,67(12):1735 — 1739.DOI:10.1016/j.bjps.2014.08.050.
35 Morrison MC.Congenital Pseudarthrosis of Clavicle [J].Proc R Soc Med,1964,57(2):94.

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