锁骨钩钢板治疗锁骨远端骨折并肩锁关节脱位的内固定取出时机与再发脱位关系  

Correlation between the removal timing of internal fixation with clavicle hook plate for the treatment of distal clavicle fracture with acromioclavicular joint dislocation and the recurrence of dislocation

作　　者：许冬青[1] 王明森[1] 王晓跃 李焕彬[1] XU Dong-qing;WANG Ming-sen;WANG Xiao-yue(Department One of Orthopaedics,Puning Hospital of Traditional Chinese Medicine,Jieyang 515300,China)

机构地区：[1]广东省普宁市中医医院骨一科,515300

出　　处：《中国实用医药》2020年第17期15-18,共4页China Practical Medicine

基　　金：揭阳市医学科学技术研究(项目编号:154)。

摘　　要：目的探讨锁骨钩钢板治疗锁骨远端骨折并肩锁关节脱位,骨折愈合后的内固定取出时机与肩锁关节再发脱位的关系。方法92例锁骨远端骨折合并肩锁关节脱位患者,均行锁骨钩钢板内固定手术治疗,根据术后在取出内固定时间不同分为半年取出组(37例)和1年取出组(55例)。半年取出组在内固定术后6个月取出内固定,1年取出组在内固定术后1年取出内固定。比较两组患者术后临床疗效,内固定术后6个月、1年、2年视觉模拟评分法(VAS)与Neer肩关节功能评分,再发脱位、再次手术情况。结果两组治疗优良率比较,差异无统计学意义(P>0.05)。半年取出组患者内固定术后1年VAS评分(1.49±1.01)分高于1年取出组的(0.98±1.14)分,差异具有统计学意义(P<0.05);半年取出组内固定术后6个月、2年的VAS评分分别为(2.14±0.78)、(0.80±0.74)分,与1年取出组的(2.31±0.92)、(1.04±0.83)分比较,差异均无统计学意义(P>0.05)。半年取出组患者内固定术后6个月、1年、2年的Neer评分分别为(85.00±3.12)、(86.95±9.93)、(86.54±9.37)分,与1年取出组的(84.04±3.73)、(87.38±9.49)、(86.93±9.95)分比较,差异均无统计学意义(P>0.05)。在本研究治疗后2年随访共观察到16例患者,再发脱位率为17.39%,其中半年取出组再发脱位5例(13.51%),1年取出组再发脱位11例(20.00%)。有10例患者再次接受了肩锁关节脱位复位内固定手术,再次手术率为62.50%,其中半年取出组再次手术4例,1年取出组再次手术6例。两组再发脱位、再次手术情况比较,差异均无统计学意义(P>0.05)。半年取出组患者再发脱位、再次手术患者Neer评分分别为(66.80±2.38)、(65.75±0.50)分,与1年取出组患者的(74.09±10.78)、(66.00±0.89)分比较,差异均无统计学意义(P>0.05)。结论锁骨钩钢板螺钉内固定术治疗合并肩锁关节脱位的锁骨远端骨折,骨折愈合率高,虽然存在取出钢板后肩锁关节再发脱位风Objective To discuss the correlation between the removal timing of internal fixation with clavicle hook plate for the treatment of distal clavicle fracture with acromioclavicular joint dislocation and the recurrence of dislocation.Methods A total of 92 patients with distal clavicle fracture with acromioclavicular joint dislocation were divided into half-year removal group(37 cases)and 1-year removal group(55 cases)according to the different removal time of internal fixation.6 months after the surgery,the internal fixation was removed in the half-year removal group,and 1 year after the surgery,the internal fixation was removed in the 1-year removal group.The clinical efficacy,visual analogue scale(VAS)score and Neer shoulder function score 6 months,1 year and 2 years after internal fixation,recurrence of dislocation and reoperation were compared between the two groups.Results There was no statistically significant difference in excellent rate of treatment between the two groups(P>0.05).1 year after internal fixation,VAS score(1.49±1.01)points of half-year removal group was higher than that of 1-year removal group(0.98±1.14)points,and the difference was statistically significant(P<0.05).6 months and 2-year after internal fixation,VAS score of half-year removal group were(2.14±0.78)and(0.80±0.74)points respectively,which had no statistically significant difference compared with those of 1-year removal group(P>0.05).6 months,1 year and 2-year after internal fixation,Neer score of half-year removal group were(85.00±3.12),(86.95±9.93)and(86.54±9.37)points,which had no statistically significant difference compared with those of 1-year removal group(84.04±3.73),(87.38±9.49)and(86.93±9.95)points(P>0.05).A total of 16 patients were observed a 2 years of follow-up,and the recurrence rate of dislocation was 17.39%,including 5 cases(13.51%)in the half-year removal group and 11 cases(20.00%)in the 1-year removal group.10 cases received reoperation,and reoperation rate was 62.50%,including 4 cases in half-year removal

关 键 词：锁骨钩钢板 锁骨远端骨折 肩锁关节脱位 术后再发脱位 

分 类 号：R687.4[医药卫生—骨科学]