锁骨钩钢板治疗肩锁关节脱位和锁骨外侧端骨折38例.DOCVIP

临床医学论文-锁骨钩钢板治疗肩锁关节脱位和锁骨外侧端骨折38例 【摘要】? 目的 探讨锁骨钩钢板治疗肩锁关节脱位和锁骨外侧端骨折的疗效。方法 38例肩锁关节脱位和锁骨外侧端骨折，肩锁关节脱位27例，Tossy Ⅱ4例，Tossy Ⅲ23例；锁骨外侧端骨折4例，均为Neer Ⅱ；肩锁关节脱位合并锁骨外侧端骨折7例，均行手术治疗。结果 术后1周开始肩关节功能锻炼，随访5～23个月，骨折均愈合，疗效评定标准参照Lazcano标准，优34例，良4例，无一例发生并发症。结论 锁骨钩钢板治疗肩锁关节脱位和锁骨外侧端骨折疗效满意。 【关键词】? 肩锁关节脱位 锁骨外侧端骨折 锁骨钩钢板 ??? Effect of clavicular hook plate on 38 cases of acromioclavicular dislocation combined with distal clavicular fracture ??? ［Abstract］? Objective? To evaluate the effects of treatment of acromioclavicular dislocation and distal clavicular fracture with hook plate.Methods? Twenty-seven patients suffered from acromioclavicular disclocation （Tossy type Ⅱ 4 cases and type Ⅲ 23 cases），4 patients with distal clavicular fracture and 7 with acromioclavicular dislocation combined with distal clavicular fracture were adimitted.All the patients were treated with open reduction and internal fixation with clavicular hook plate.Results? One weeks after operation，all the patients began the function exercise of shoulder joint，the cases were followed up for 5 to 23 months，34 cases were excellent and 4 cases were satisfactory according to the Lazcano standard.No complications were observed in all the cases.Conclusion? The clavicular hook plate is a good choice in the treatment of acromioclavicular dislocation and distal clavicular fracture. ??? ［Key words］? acomioclavicular dislocation;distal davicular fracture;clavicular hook plate ??? 肩锁关节脱位和锁骨外端骨折在临床上并不少见，ROWE［1］的资料指出，肩锁关节脱位和锁骨外端骨折约占肩部损伤脱位的12%，其治疗方法较多且多有争议，效果不一。笔者自2001年8月～2004年12月应用AO锁骨钩钢板治疗肩锁关节脱位及锁骨外侧端骨折38例，经随访，治疗效果满意，现报告如下。 ??? 1? 临床资料 ??? 1.1? 一般资料? 本组38例，男29例，女9例，年龄24～54岁，平均31岁。肩锁关节脱位27例，Tossy Ⅱ 4例，Tossy Ⅲ 23例；锁骨外侧端骨折4例，均为Neer Ⅱ；肩锁关节脱位合并锁骨外侧端骨折7例。致伤原因：交通事故伤28例，跌伤8例，其他2例，均为新鲜损伤，全部病例均在伤后3～7天内行手术治疗。 ??? 1.2? 手术方法? 采用全麻或高位臂丛神经麻醉，仰卧位患侧垫高，切口自肩峰外侧缘经肩锁关节至锁骨外侧段，长度以能暴露肩锁关节及锁骨外端或锁骨骨折处为宜，肩峰处的暴露能插入锁骨钢板钩子并使之能钩牢肩峰后下缘即可；清理肩锁关节后，将钩直接从肩锁关节偏后方插入肩峰下，复位脱位的肩锁关节或骨折的锁骨，再以钢板贴合锁骨上钻孔，测深，攻丝和安装适当长度的螺钉，缝合好关节囊，修补断裂的肩锁韧带和喙锁韧带，重叠缝合三角肌和斜方肌。 ??? 1.3? 结果? 术后均用屈肘三角巾悬吊患肢1周，术后1