肩锁关节脱位合并喙突骨折22例疗效分析  

Clinical efficacy of 22 cases of acromioclavicular dislocation associated with coracoid fractures

作　　者：朱和平 张盘军 王勇 Zhu Heping;Zhang Panjun;Wang Yong(Department of Orthopedics,the Affiliated Yixing Hospital of Jiangsu University,Yixing 214200,China)

机构地区：[1]江苏大学附属宜兴医院骨科,宜兴214200

出　　处：《中华实验外科杂志》2024年第4期855-858,共4页Chinese Journal of Experimental Surgery

基　　金：无锡市第二届双百中青年医疗卫生拔尖人才项目(BJ2023106)。

摘　　要：目的探讨22例肩锁关节脱位(ACD)合并喙突骨折(CF)的治疗效果。方法2017年3月至2023年8月宜兴市人民医院骨科收治22例ACD合并CF患者,男15例,女7例,平均年龄49(27~67)岁,受伤原因:车祸5例,骑电动车摔倒9例,高处坠落6例,重物砸伤和机器挤压伤各1例。ACD分型为,Rockwood变异型Ⅲ型20例,变异型Ⅳ型2例。CF分型为,EyresⅢA型12例,ⅣA型6例,ⅤA型4例,OgawaⅠ型18例,Ⅱ型0例,CF按骨折形态分类为,铰链骨折15例,平移骨折3例,撕脱骨折4例。10例ACD行切开复位锁骨钩钢板(CHP)内固定术,CF行保守治疗(TC)(CHP+TC);12例ACD行CHP内固定术,CF予空心螺钉(CS)固定(CHP+CS)。观察并记录ACD和CF复位、固定情况、术后并发症、喙突骨愈合时间、末次视觉模拟评分(VAS)、末次Constant评分和DASH评分。结果CHP+TC:ACD复位及固定满意,5例CF解剖复位,均为EyresⅢA型,其中铰链骨折3例,撕脱骨折2例;随访42(5~84)个月,喙突骨愈合时间2.6(2~3.5)个月,末次VAS评分0.4(0~2)分、末次Constant评分99(96~100)分、末次DASH评分6(0~10)分,发现肩峰下骨溶解(AO)3例,喙突骨不连(CN)1例,喙突畸形愈合(CM)4例。CHP+CS:ACD复位及固定满意,8例CF解剖复位,其中EyresⅢA型5例、ⅣA型2例、ⅤA型1例,铰链骨折5例,平移骨折3例;随访37(13~70)个月,喙突骨愈合时间2.9(2~3.5)个月,末次VAS评分0.5(0~3)分、末次Constant评分98(96~100)分、末次DASH评分6(2~10)分,发现AO 4例,CN 1例,CM 3例,喙突螺钉穿出边界3例。所有病例的Constant评分和DASH评分按优良率判断,均为优;所有病例未见切口感染、喙突下撞击综合征、肩锁关节再脱位等并发症。结论治疗Rockwood变异Ⅲ型和Ⅳ型ACD合并EyresⅢ~Ⅴ型CF时,可先使用CHP复位、固定ACD,再根据CF间接复位情况,决定保守治疗或螺钉固定,可取得满意疗效。Objective To explore clinical efficacy of 22 cases of acromioclavicular dislocation(ACD)combined with coracoid fractures(CFs).Methods Totally,22 patients with ACD associated with CFs were admitted to Department of Orthopedics of Yixing People’s Hospital from March 2017 to August 2023,of which 15 were males and 7 females with a mean age of 49 years(range,27-67).The causes of injury included traffic accident in 5 patients,falling from electric bikes in 9 patients,fall from height in 6 patients,and hit by a heavy object and crush injury of machine in one patient each.Rockwood classification of ACD was variation typeⅢin 20 patients and variation typeⅣin 2 patients.Eyres classification of CF was typeⅢA in 12 patients,typeⅣA in 6 patients and typeⅤA in 4 patients.Ogawa classification of CF was typeⅠin 18 patients and typeⅡin no patient.The morphological classification of CF was hinge fractures in 15 patients,translational fractures in 3 patients and avulsion fractures in 4 patients.A total of 10 cases of ACD were given open reduction and internal fixation using clavicular hook plates(CHPs)and CFs were treated conservatively(TC)(CHP+TC),while 12 cases if ACD received open reduction and internal fixation using CHPs and CFs were operated with cannulated screws(CS)(CHP+CS).Reduction and fixation of ACD and CFs,postoperative complications,bone union time of CFs,visual analog scale(VAS)score and Constant score and disabilities of the arm,shoulder and hand(DASH)score at the last follow-up were observed and recorded.Results CHP plus TC in 10 patients:ACD was reduced and fixed satisfactorily.Eyres typeⅢA fractures in 5 cases were reduced anatomically,of which hinge fractures in 3 cases and avulsion fractures in 2.A total of 10 cases were followed up with an average of 42 months(range,5-84),the average bone union time of CF was 2.6(range,2-3.5)months.At the last follow-up,the mean score of VAS was 0.4(range,0-2),the average scores of Constant and DASH were 99(range,96-100)and 6(range,0-10),respectively.Acromion

关 键 词：肩锁关节脱位 喙突骨折 内固定 锁骨钩钢板 

分 类 号：R687.3[医药卫生—骨科学]