锁骨钩钢板治疗锁骨远端骨折脱位的并发症分析  

Complications of treatment of acromioclavicular joint dislocation and unstable distal clavicular fracture with clavicular hook plate

作　　者：朱义用[1] 崔恒燕[1] 蒋盘强[1] 汪建良[1] 

机构地区：[1]无锡市中医医院骨伤科,江苏无锡214001

出　　处：《中国骨伤》2013年第11期927-931,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨锁骨钩钢板治疗TossyⅢ型肩锁关节脱位和NeerⅡ型锁骨远端骨折术后并发症的原因及其防治方法。方法:2001年1月至2011年12月,采用锁骨钩钢板分别治疗TossyⅢ型肩锁关节脱位246例和NeerⅡ型锁骨远端骨折222例。其中男348例,女120例;年龄21～80岁,平均45.4岁;受伤至手术时间1 h～15 d,平均30.8 h。所有患者受伤前肩关节活动正常。根据Karlsson评定标准,将肩关节功能恢复优良者归为正常组、肩关节功能差者为异常组,对两组肩关节的前屈、后伸、内收、外展和上举进行比较,总结钢板钩撞击肩峰、肩峰下骨质磨损、肩锁关节炎、锁骨应力骨折、肩锁关节向下半脱位、脱钩和断钩的情况。结果:468例均获随访,时间8～48个月,平均12.5个月。按照Karlsson评定标准,优308例,良76例,差84例。两组肩关节前屈、后伸、内收、外展和上举的差异均有统计学意义(P<0.01)。异常组患者中,41例(8.76%)钢板钩撞击肩峰或位置不佳,12例(2.56%)肩峰下骨质磨损或肩峰下滑囊炎,10例(2.14%)肩锁关节炎和锻炼太晚引起肩痛不适,7例(1.50%)锁骨应力性骨折或钢板内侧端翘起,6例(1.28%)肩锁关节向下半脱位,5例(1.07%)脱钩,3例(0.64%)断钩。结论:锁骨钩钢板是治疗TossyⅢ型肩锁关节脱位和NeerⅡ型锁骨远端骨折的较好方法,术中正确放置钢板钩的位置、适当将钢板钩预弯、修复肩锁关节周围纤维结构以及合理功能锻炼有助于减少并发症的发生。Objective ：To investigate the causes and prevention of the complications about treatment of acromioclavicular joint dislocation （Tossy Ⅲ） and unstable distal clavicular fracture （Neer Ⅱ ） with clavicular hook plate. Methods：From January 2001 to December 2011,246 patients with acromioclavicular joint dislocation （Tossy Ⅲ ） and 222 patients with unstable distal clavicular fracture （Neer Ⅱ ） were treated with acromioclvicular hook plate fixation,including 348 males and 120 females with an average age of 45.4 years old ranging from 21 to 80 years old. The mean time from injury to operation was 30.8 hours （ranged from 1 h to 15 d）. All patients had normal shoulder function before injury. According to Karlsson evaluation standard, the cases with excellent and good function of the shoulder joint were regarded as the normal group, and the cases with poor function of shoulder joint as the abnormal group. The comparison of the range of forward flexion ,backward stretch, adduction, abduction and elevation of shoulder joints between two groups was performed. The data of impingement, subacromial osteolysis,acromioclavicular arthritis, clavicular stress fracture,downward acromioclavicular joint subluxation, hook cut-out and hook break were summarized. Results：All patients were followed up from 8 to 48 months with an average of 12.5 months. The results were excellent in 308 cases, good in 76, and poor in 84 according to Karlsson evaluation. The excellent and good rate was 82.1%. The difference of the range of forward flexion, backward stretch, adduction, abduction and elevation of shoulder joints between two groups had a statistically significant difference （P〈0.01）. Among 84 poor cases,there were 41 （8.76%） in acromial impingement or inadequate place of plate hook, 12 （2.56%） with subacromial osteolysis or/and bursitis, 10 （2.14%） with acromioclavicular arthritis or painful shoulder caused by delayed dirigation, 7 （ 1.50% ） with clavicular stress fracture or interal plate

关 键 词：肩锁关节 肩脱位 锁骨 骨折 手术后并发症 

分 类 号：R683.1[医药卫生—骨科学]