锁骨远端-肩峰下表面角对锁骨钩钢板治疗效果影响的临床研究  

Study on the effect of distal clavicle-acromion coronal angle on the treatment with clavicle hook plate

作　　者：薛禹伦 郑伟伟 胡丹[1] 吴恺伦 郭炯炯[3] XUE Yu-lun;ZHENG Wei-wei;HU Dan;WU Kai-lun;GUO Jiong-jiong(Department of Orthopedics and Sports Medicine Center,Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou,Jiangsu,215000,China)

机构地区：[1]南京医科大学附属苏州医院骨科与运动医学中心,江苏省215000 [2]苏州大学附属第四医院骨科,江苏省215125 [3]苏州大学附属第一医院骨科,江苏省215006

出　　处：《中国骨与关节杂志》2024年第12期983-989,共7页Chinese Journal of Bone and Joint

摘　　要：目的探讨锁骨远端-肩峰下表面角(α角)与治疗效果的关系并分析其作为预期锁骨钩钢板疗效因素的可行性。方法回顾分析2013年1月至2021年6月收治的267例肩锁关节脱位及锁骨远端骨折采用锁骨钩钢板治疗的患者,其中交通事故伤125例,跌倒伤86例,坠落伤42例,砸压伤14例;NeerⅡ型锁骨远端骨折98例,RockwoodⅢ型、Ⅳ型、Ⅴ型分别为128例、15例、26例。根据α角大小将其分为3组:A组110例,0°<α<20°;B组101例:20°<α<30°;C组56例:α>30°。统计其并发症率与α角的关系,同时统计锁骨远端骨折分型和肩锁关节脱位分型对并发症率的影响。结果总并发症为38例,其中螺钉松动3例,钢板断裂1例,锁骨钩断裂1例,脱钩6例,骨折移位3例,钢板近端骨折1例,严重肩关节疼痛伴活动受限23例,其中确诊肩袖损伤12例。锁骨远端骨折分型和肩锁关节脱位分型对并发症率没有影响(P>0.05)。C组的总并发症率、脱钩率、肩袖损伤率均大于A组和B组,差异有统计学意义(P<0.05)。B组的严重肩关节疼痛伴活动受限率小于A组和C组,差异有统计学意义(P<0.05)。结论α角是锁骨钩钢板治疗效果的一个影响因素,α角增大会增加锁骨钩钢板治疗的并发症率,尤其是脱钩率,它可作为术前手术疗效的一个参考指标并帮助选择术中钩钢板,改善患者预后。Objective To investigate the relationship between distal clavicle-acromion coronal angle(αangle)and therapeutic effect,and analyze the feasibility ofαangle as an predictive factor of the therapeutic effect while using clavicle hook plate.Methods A retrospective analysis was conducted on 267 patients with acromioclavicular dislocation or distal clavicle fracture treated with clavicle hook plate from January 2013 to June 2021.There were 125 cases of traffic accident,86 cases of fall injury,42 cases of drop injury and 14 cases of crush injury.Clavicle distal fracture of Neer typeⅡ:98 cases.Acromioclavicular dislocation of Rockwood typeⅢ/Ⅳ/Ⅴ:128/15/26 cases.The patients were divided into three groups byαangle.Group A:0°<α<20°,110 patients;Group B:20°<α<30°,101 patients;Group C:α>30°,56 patients.The relation between complication rate andαangle was calculated.The relationship between the classifications of distal clavicle fracture and acromioclavicular dislocation,and the complication rate were also analyzed.Results There were 38 cases of total complications,including 3 cases of screw loosening,1 case of steel plate breakage,1 case of hook rupture,6 cases of unhooking,3 cases of fracture displacement,1 case of fracture around the proximal plate and 23 cases of severe shoulder pain with limited mobility,among whom 12 cases of rotator cuff was diagnosed.There was no relationship between classifications of distal clavicle fracture,acromioclavicular dislocation and the complication rate in this study(P>0.05).The total complication rate of Group C was greater than that of Group A and B(P<0.001).The rates of unhooking and rotator cuff rate were higher in the Group C than that in the Group A and B(P<0.05).The rate of severe shoulder pain with limited mobility in Group B was lower than that in the Group A and C(P<0.05).Conclusionsαangle is an influential factor for the treatment effect with clavicle hook plate.Largerαangle can increase the complication rate of clavicle hook plate treatment,especially the

关 键 词：肩锁关节 关节脱位 骨折 锁骨 骨板 

分 类 号：R683.4[医药卫生—骨科学]