喙锁间带袢钢板内固定术后特有并发症的原因与预防对策:十年随访分析  

Risk factors and preventive strategies for specific complications after coracoclavicular suture button fixation:ten years follow-up analysis

作　　者：汪李军[1] 范胜利[1] 吴健[1] 唐天驷[2] Lijun Wang;Shengli Fan;Jian Wu;Tiansi Tang(Department of Orthopaedics,Changshu No.2 People's Hospital,Changshu 215500,China;Department of Orthopaedics,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]常熟市第二人民医院创伤骨科,215500 [2]苏州大学附属第一医院骨科,215006

出　　处：《中华肩肘外科电子杂志》2022年第3期244-252,共9页Chinese Journal of Shoulder and Elbow(Electronic Edition)

摘　　要：目的分析带袢钢板内固定术后特有并发症的发生原因,总结相应预防对策。方法回顾性分析自2011年9月至2020年7月113例接受带袢钢板内固定术的肩锁关节脱位及锁骨远端骨折患者临床资料,其中男42例、女71例;平均年龄(54.3±9.6)岁;TossyⅢ型肩锁关节脱位76例、ChoⅡ型锁骨远端骨折37例;手术时间为伤后1~12 d,平均4.2 d。根据患肩正位片评估内植物位置及复位状态,采用Karlsson分级系统评估术后肩关节功能,观察记录手术并发症,闭环式分析并发症发生原因及相应预防措施。结果113例术后获随访16个月至10年,平均39.1个月。锁骨远端骨折组中,术中定位导针穿透喙突基底时,发生1例臂丛神经一过性损伤。肩锁关节脱位组中,术中发现喙突骨折漏诊1例,手术中转为锁骨钩钢板内固定;术后第2天摄片发现另1例喙突骨折,知情同意后,予锁骨带外固定制动;发现1例患者锁骨上袢钢板滑脱至锁骨下,肩锁关节复位完全丢失,知情同意后,予非计划二次手术调整;发现7例肩锁关节复位部分丢失、予锁骨带外固定制动;术后4个月发现1例切口迟发感染,取出内植物并使用敏感抗生素后,伤口愈合;11例患者在术后1~7个月先后出现复位完全丢失。根据Karlsson分级标准,评估患者术后1年时的肩关节功能,肩锁关节脱位组Karlsson分级优55例、良13例、差8例(优良率89.5%);锁骨远端骨折组Karlsson分级优29例、良5例、差3例(优良率91.9%)。结论喙锁间带袢钢板技术虽然操作简易,但术中需注意的细节较多,选择合适的钻孔位置和钻孔方向至关重要。Background Acromioclavicular instability is a frequent injury affecting young and athletic populations.Symptomatic,high-grade dislocations are suggested to be managed by various surgical procedures that utilize different grafts to achieve healing with a pain-free shoulder.Currently,the two modern techniques widely used are hook plate fixation and coracoclavicular ligament fixation using a suspensory loop device.Objective To investigate the causes and preventive strategies for specific complications after coracoclavicular suture button fixation.Methods A retrospective study was conducted to analyze the clinical data of 113 patients with acromioclavicular dislocations or distal clavicle fractures admitted to Changshu No.2 People's Hospital from September 2011 to July 2020.Seventy-six patients who suffered acromioclavicular dislocations were categorized as Tossy classification typeⅢ,while 37 who suffered distal clavicle fractures were classified as Cho classification typeⅡ.There were 42 males and 71 females with an average age of(54.3±9.6)years(23 to 78 years).All patients were operated on after an average of 4.2 days from the initial injury.The anteroposterior radiographs of the affected shoulder were performed to evaluate the position of the implants and the reduction.The Karlsson degree system was used to assess the functional recovery of the affected shoulder.Specific complications related to the hardware or the surgical technique were recorded to explore the causes and related preventions.Results The mean follow-up period was 39.1 months(16 to 120 months).In the distal clavicle fracture group,one case suffered transient brachial plexus injury when a guide pin was drilled through the base of the coracoid process and recovered immediately with no dysfunction.In the acromioclavicular dislocation group,one case received unanticipated hook plate fixation as a coracoid process fracture was found during the procedure.Another coracoid process fracture and loss of reduction on radiographs were detected one day afte

关 键 词：并发症 锁骨 远端 肩锁 脱位 

分 类 号：R687.4[医药卫生—骨科学]