肩锁关节脱位的手术治疗及护理.DOCVIP

临床医学论文-肩锁关节脱位的手术治疗及护理 【摘要】? 目的 评估锁骨钩钢板+异体肌腱移植重建喙锁韧带的手术疗效及总结护理经验。方法 17例肩锁关节脱位患者采用锁骨钩钢板固定，同时利用新鲜冰冻异体肌腱移植重建喙锁韧带,术前进行护理评估,针对患者特点做好心理护理和准备工作,消除患者的恐惧紧张心理,使患者主动配合手术治疗。术后予有效护理及康复治疗,并随访评估疗效。结果 依据Karlsson标准评定疗效，优良率为93%。术后早期恢复肩关节功能，远期疗效佳，并发症少。结论 此种手术方式有效提供了早期机械稳定性及晚期生物学稳定,疗效确切。做好围术期护理对于防止并发症、促进患肢功能恢复有重要意义。 【关键词】? 肩锁关节脱位；内固定；喙锁韧带重建；护理 ????? Operative treatment and nursing of acromioclavicular dislocation ???? ［Abstract］? Objective? To evaluate the clinical effects of clavicular hook plate + allogentic tendon grafts and summarize nurse experience in the treatment of acromioclavicular dislocations.Methods?Seventeen cases of severe acromioclavicular dislocation received open reduction and clavicular hook plate fixation,the coracoclavicular ligaments were reconstructed by freeze allogentic tendons,and physiological state was evaluated before operation,so as to eliminate dread mentation psychology and match the treatment.Efficient nurse and rehabilitation was given after operation.Results?The good and excellent rate was 93% according to Karlsson evaluated standard.The shoulder function recovered early,and the late effects were good,with less complication.Conclusion?Such operation method produces sufficient mechanic stability and biological stability in the early and late postoperation stage respectively.Perioperation nurse is important to prevent complication and improve?the injury limb抯 function recovery. ??? ［Key words］? acromioclavicular dislocation; internal fixation; coracoclavicular ligament reconstruction;nurse ??? 锁骨钩钢板已广泛应用于重度肩锁关节脱位的治疗,具有疗效确切、术后早期可恢复关节功能等优点,但也在一定程度上影响了骨科医生对恢复喙锁韧带结构完整性的重视,手术操作上常常因为喙锁韧带较短,难以寻找,韧带修复相当困难,流于形式，以致内固定钢板取出后肩锁关节脱位复发。鉴于此，我们在锁骨钩钢板固定的基础上行异体肌腱移植重建喙锁韧带，最终达到肩锁关节的生物稳定。2002～2005年,我科开展此类手术17例,并进行随访。结果显示远期疗效佳，现总结报告如下。 ??? 1? 资料与方法 ??? 1.1? 一般资料? 本组急性肩锁关节脱位依据Tossi分类均为3型,共计17例,男12例,女5例,年龄17～52岁,平均30岁,左侧11例,右侧6例,均为单侧。伤因:车祸伤11例,重物砸伤2例,高处坠落伤2例,运动伤1例,打击伤1例。受伤距手术时间7 h～14天。合并伤：颅脑损伤2例,同侧肘关节骨折1例。 ??? 1.2? 手术方法? 患者取仰卧位，臂丛神经麻醉，患肩垫高，切口于锁骨中外1/3处远端向肩峰延伸，近端向内下方，切开深筋膜探查