摘要
目的探讨锁骨钩钢板内固定治疗NeerⅡ型锁骨远端骨折和TossyⅢ型肩锁关节脱位的临床效果以及并发症。方法21307年8月至2012年2月，以锁骨钩钢板内固定治疗NeerⅡ型锁骨远端骨折22例和TossyⅢ型肩锁关节脱位16例，对临床应用效果及术后并发症进行回顾性分析。结果术后所有患者切口均获得一期愈合，其中30例获随访，随访时间6．00—18．00个月，平均（10．45±3．78）个月，于术后6～14个月后行内固定物取出术，术后未出现再骨折或者肩锁关节再次分离现象发生。其中4例患者出现并发症，术后7d内脱钩1例，术后3周脱钩1例，术后3月余发生锁骨应力性骨折1例，该3例患者给予再次手术治疗，1例术后一直存在肩部异响，行内固定取出后异响消失。锁骨钩板取出前后肩关节功能按洛杉矶加利福尼亚大学（UCLA）肩关节等级评分标准进行评定，锁骨钩板取出前后的肩部疼痛[（7．90±1．20）分、（9．20±1．03）分，t=-2．327，P=0．045]、肩关节功能[（8．00±0．94）分、（9．40±0．97）分、t=-3．280、P=0．010]、向前侧屈范围[（4．00±0．47）分、（4．70±0．48）分，t=-4．583、P=0．001]等方面差异均有统计学意义。患肩功能在钩板取出后达到改善，总体疗效优15例，良13例，差2例，优良率93．33％。结论应用锁骨钩板内固定治疗NeerⅡ型锁骨远端骨折和TossyⅢ型肩锁关节脱位临床效果良好，但需注意其并发症的预防及处理。
[ Abstract] Objective To investigate therapy effect and its clinical complications of the clavicular hook plate internal fixation for the treatment of Type Neer Ⅱ distal clavicle fracture and tossy Ⅲ acromioclavicular joint dislocation. Methods Twenty-two patients of Neer Ⅱ distal clavicle fracture and 16 patients of Tossy Ⅲ acromioclavieular joint dislocation were selected as our subjects. All patients were hospitalized and treated by using clavicular hook plate fixation form August 2007 to Februay 2012. The clinical effect and complications were analyzed retrospectively. Results All patients were showed the primary healing in terms of incision. Of all patients,30 cases were being following up,and follow-up periods was 6. 0 to 18. 0 months （average of （10. 45 ± 3.78 ） months）. All patients underwent implant removal surgery at postoperative 6 - 14 months. No refracture or acromioclavicular joint separation again occurred. Four patients were with complications ,of which ,2 patients were clavicular hook plate decoupling at 7 days or 3 weeks after operation; One patient occurred clavicle stress fracture at more than 3 months after operation. All mentioned 3 cases were treated with re-operation. 1 patient was with shoulder abnormal sound after operation and abnormal sound disappear after internal fixation removed. The shoulder functions were evaluated according to University of California-Los Angele~ （UCLA） score system at before and after clavicular hook plate was taken out. The scores of pain and function of the shoulder, forward lateral flexion range were significant difference between before and after clavicular hook plate removed （ （7.90 ± 1.20） vs. （9.20±1.03）,t = -2.327,P=0.045;（8.00±0.94） vs. （9.40±0.97）,t = -3.280,P= 0. 001 ; （4.00 ±0.47 ） vs. （4.70 ± 0. 48 ）, t = - 4. 583, P = 0. 001 ）. After the hook plate was removed, all shoulder functions showed improvement. The overall efficacy was excellent in 15 eases , good in 13 eases , and poor in 2 cases ,and the recovery of excellent and good rate were 93.33% . Conclusion The clinical efficacy is well in terms of using clavicular hook plate internal fixation to treat Type Neer Ⅱ distal clavicle fracture and Tossy Ⅲ aeromioclavieular joint dislocation. Prevention and treatment of complications should paid more attention.
出处
《中国综合临床》
2013年第11期1215-1218,共4页
Clinical Medicine of China
