摘要
目的探讨锁骨钩钢板内固定治疗新鲜TossyⅢ型肩锁关节脱位和NeerⅡ型锁骨远端骨折的临床疗效、并发症及内固定取出的必要性。方法2005年6月-2008年6月,收治24例TossyⅢ型肩锁关节脱位和20例NeerⅡ型锁骨远端骨折患者。男32例,女12例;年龄18～66岁,平均38.5岁。左侧18例,右侧26例。均为新鲜闭合骨折、脱位。致伤原因:交通伤31例,坠落伤13例。受伤至手术时间2～8d,平均4d。术中采用锁骨钩钢板内固定治疗,肩锁关节脱位复位固定后,未修复断裂喙锁韧带。按照洛杉矶加利福尼亚大学肩关节等级评分系统(UCLA)评定肩关节功能,并对内固定取出前后肩关节的功能状况进行分析。结果术后1周2例切口发生感染,经对症治疗痊愈;其余患者切口均Ⅰ期愈合。术后1周1例发生钢板脱钩,再次手术行钩钢板固定。1例术后3d内肩部剧烈疼痛,去除钢板更换克氏针固定后症状缓解。38例获随访,随访时间8～32个月,平均18个月。无内固定断裂,锁骨远端骨折于术后3～6个月愈合,平均4.2个月。38例末次随访时(内固定去除术前),根据UCLA评定肩关节功能,获优11例,良22例,可5例,优良率为86.8%。20例术后肩关节疼痛患者于3～16个月取出钢板,平均10个月。取出术后患者均获随访,随访时间3～8个月,平均5个月。内固定取出后无再脱位及骨折发生。内固定取出前及取出后UCLA总评分分别为(30.55±4.00)分及(33.85±1.95)分,差异有统计学意义(P<0.01)。结论锁骨钩钢板内固定是治疗新鲜TossyⅢ型肩锁关节脱位和NeerⅡ型锁骨远端骨折的有效方法之一。术中规范操作、钢板正确塑形及术后积极功能锻炼是预防并发症的有效方法。对于术后肩部有症状的患者,宜取出内固定以改善肩关节功能。
Objective To investigate the clinical efficacy,complications and necessity of removing internal fixation in treatment of fresh Tossy type III acromioclavicular joint dislocations and Neer type II distal clavicle fractures with clavicular hook plate.Methods From June 2005 to June 2008,24 patients with fresh Tossy type III acromioclavicular joint dislocations and 20 patients with fresh Neer type II distal clavicle fractures were treated.There were 32 males and 12 females with an age range of 18-66 years（38.5 years on average）,involving 18 left shoulders and 26 right shoulders.The injury was caused by traffic accident in 31 cases and by falling in 13 cases.The mean time from injury to operation was 4 days（range,2-8 days）.All patients were treated by reduction with clavicular hook plate fixation.The coracoclavicular ligaments were not sutured.The shoulder functions were evaluated according to University of California-Los Angeles（UCLA）score system and analysed before and after removing internal fixation.Results Wound infection occurred in 2 cases 1 week after operation and healed after symptomatic managment,the other incisions healed by first intention.One case accepted hook plate fixation again because of loosening hooking-up 1 week after operation.One case accepted hook plate removal and Kirschner wire fixation because of severe shoulder’s pain on the postoperative third day.Thirty-eight patients were followed up for 8-32 months（18 months on average）,there was no plate breakage.Clavicle fractures got bony union after 3-6 months（4.2 months on average）.At last follow- up（before plate removal）,according to UCLA shoulder function score system,the results were excellent in 11 cases,good in 22 cases,and fair in 5 cases;the excellent and good rate was 86.8%.Because of shoulder’s pain,plates were removed in 20 patients 3-16 months（10 months on average）after operation.The cases were followed up 3-8 months（5 months on average）after removingplate.No dislocation and fracture occurred again.There was statistically significant difference（P0.01）in the functional scores of shoulder between before（30.55±4.00）and after removing internal fixation（33.85±1.95）.Conclusion Clavicular hook plate fixation is an effective treatment for fresh Tossy type III acromioclavicular joint dislocations and Neer type II distal clavicle fractures.Normative operating,correct plate moulding,functional rehabilitation after operation are key factors in preventing complications and reaching good clinical efficacy.For the patients with postoperative symptoms,the plate should be removed to improve the shoulder’s function.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第1期69-73,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
TossyⅢ型肩锁关节脱位
NeerⅡ型锁骨远端骨折
锁骨钩钢板
内固定
Tossy type III acromioclavicular joint dislocation Neer type II distal clavicle fracture Clavicular hook plate Internal fixation
