锁骨钩钢板内固定治疗肩锁关节脱位失败原因分析及对策.docVIP

精品论文 参考文献 锁骨钩钢板内固定治疗肩锁关节脱位失败原因分析及对策 刘三强 李江兴（通讯作者） 　　甘肃省天水市清水县人民医院 清水县 741400 　　摘要：目的：探讨锁骨钩钢板内固定治疗肩锁关节脱位失败的原因与对策。方法：自2010-01—2015-03应用锁骨钩钢板内固定治疗肩锁关节脱位83例，失败10例，失败率12%，对其相关因素进行分析。结果：2例锁骨钩未有效固定至肩峰下方，肩锁关节脱位未有效复位及固定；1例锁骨钩高度选择不当，致肩锁关节过度复位；2例因对钩钢板认识不足，误将锁骨钩插入肩锁关节囊后侧，致术后肩部活动受限，间断性出现活动疼痛。螺钉松动2例，钢板折弯1例，钩断裂1例。钢板造成的其他影响：肩峰撞击、肩峰磨损骨溶解、肩袖损伤、肩部疼痛、肩关节活动受限1例。结论：掌握受伤机制、分型及临床表现，熟悉肩锁关节解剖、锁骨钩钢板结构原理，术中清楚显露锁骨后侧部分肩峰骨质，使锁骨结构钢板却是插入肩峰下方，能有效减少医院性失误；对于肩峰撞击、骨溶解等结构性并发症，可适当提前取出内固定；或采用Endobutton带袢钢板固定，可避免肩峰下内容物，有效减少肩峰撞击、磨损、肩袖损伤等并发症。 　　关键词：肩锁关节脱位；锁骨钩钢板；内固定；失败原因 　　Abstract：objective to explore the treatment of clavicular hook plate fixation failure reasons and countermeasures of the acromioclavicular joint dislocation. Since the 2010-01-2015-03 application clavicular hook plate fixation in the treatment of 83 cases of the acromioclavicular joint dislocation，10 cases of failure，failure rate 12%，analyze its related factors. Results 2 cases of clavicle hook is not effective under the fixed to the shoulder peak，the acromioclavicular joint dislocation without effective reduction and fixation；Improper selection 1 case of clavicle hook height to excessive reset the acromioclavicular joints；2 cases due to insufficient understanding of hook plate，mistaking clavicle hook into the acromioclavicular joint capsule behind，postoperative shoulder activity limitations，intermittent showed activity of pain. Screw loosening in 2 cases，the steel plate bending in 1 case，hook fracture in 1 case. The other impact of the steel plate：shoulder peak impact，wear shoulder peak bone dissolve，rotator cuff injury，pain in the shoulder，shoulder joint limited activities in 1 case. Conclusion mastering injury mechanism，classification and clinical manifestation，familiar with the acromioclavicular joint anatomy，clavicular hook plate structure theory，intraoperative clearly exposed collarbone back part of the shoulder peak bone mass，the collar bone structure steel plate is inserted below the shoulder peak，can effectively reduce the hospi