胸锁关节解剖锁定钢板联合韧带重建治疗胸锁关节前脱位  

Treatment of anterior dislocation of sternoclavicular joint with sternoclavicular joint anatomical locking plate combined with ligament reconstruction

作　　者：周举 阳运康 张利萍 孙远林 向飞帆 杨琨 ZHOU Ju;YANG Yunkang;ZHANG Liping;SUN Yuanlin;XIANG Feifan;YANG Kun(Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou 646000,China;Department of Pediatric, Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Department of Orthopaedics, First People’s Hospital of Yibin, Yibin 644000,China;Department of Orthopaedics, People’s Hospital of Luzhou, Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院骨与关节外科,泸州646000 [2]西南医科大学附属医院儿科,泸州646000 [3]宜宾市第一人民医院骨科,644000 [4]泸州市人民医院骨科,646000

出　　处：《国际骨科学杂志》2019年第3期165-170,共6页International Journal of Orthopaedics

基　　金：四川省科技计划项目(2014JY0248);泸州市科技计划项目[2016-S-67(14/23)];西南医科大学基金项目(2013ZRQN069);西南医科大学附属医院基金项目(2017-PT-47)

摘　　要：目的观察胸锁关节解剖锁定钢板联合韧带重建治疗胸锁关节前脱位的疗效。方法选取2015年1月至2018年1月西南医科大学附属医院骨科10例胸锁关节前脱位患者,行胸锁关节解剖锁定钢板联合韧带重建治疗。其中男7例、女3例,年龄(42.20±8.08)岁。所有患者在伤后2周内接受手术治疗,以Rockwood评分评价患者术前及术后肩关节功能。术后随访9～15个月,平均(12.05±1.19)个月。结果术后X线摄片示复位满意。术前、术后3d、1个月、6个月及末次随访时患者Rockwood评分分别为(5.30±1.16)分、(8.20±0.79)分、(10.30±1.06)分、(13.40±1.26)分和(13.50±1.18)分。与术前比较,术后3dRockwood评分明显改善(P<0.05);术后1个月评分较术后3d有所改善(P<0.05);术后6个月较术后1个月明显改善(P<0.05);末次随访时与术后6个月的评分无差异(P>0.05)。末次随访时患者肩功能评分优8例、良2例,优良率为100%。未见血管神经损伤、内固定松动及断裂、胸锁关节疼痛及包块等并发症发生。结论胸锁关节解剖锁定钢板联合韧带重建治疗胸锁关节前脱位可达到固定牢靠、并发症少、关节功能恢复好的效果,可作为处理胸锁关节前脱位的新方法。Objective To investigate the efficacy of sternoclavicular joint anatomical locking plate combined with ligament reconstruction in the treatment of anterior dislocation of the sternoclavicular joint.Methods Ten patients with anterior dislocation of the sternoclavicular joint who visited Department of Orthopaedics,Affiliated Hospital of Southwest Medical University from January 2015 to January 2018 were treated with sternoclavicular joint anatomical locking plate combined with ligament reconstruction.There were 7 males and 3 females,with an average age of 42.20±8.08 years.All patients received surgical treatment within 2 weeks after injury.Preoperative and postoperative shoulder joint function were evaluated with Rockwood scores.The postoperative follow-up was 9 to 15 months,with an average of(12.05±1.19)months.Results Postoperative X-ray showed satisfactory reduction.The patients’ Rockwood scores were(5.30±1.16),(8.20±0.79),(10.30±1.06),(13.40±1.26)and(13.50±1.18)before operation,at 3 days,1 month,6 months and the last follow-up,respectively.Compared with the preoperative evaluation,the Rockwood score was significantly improved at 3 days after surgery(P<0.05).The score at 1 month after surgery was further improved compared with that at 3 days after surgery(P<0.05).The score at 6 months after surgery was significantly improved compared with that at 1 month after surgery(P<0.05).There was no significant difference in the score between the last follow-up and 6 months after surgery(P>0.05).In the last follow-up,8 cases were excellent and 2 cases were good in term of the patient shoulder function score,with an excellent and good rate of 100%.The complications,such as neurovascular injury,implant failure or loosening,pain and prominence of the sternoclavicular joint,were not observed.Conclusion Anatomical locking plate combined with ligament reconstruction may be an alternative for treatment of anterior dislocation of the sternoclavicular joint,with reliable fixation,few complications and satisfactory function.

关 键 词：胸锁关节解剖锁定钢板 胸锁关节前脱位 韧带重建 治疗 

分 类 号：R687.4[医药卫生—骨科学]