锁骨钩板治疗致肩峰下撞击征预防.docVIP

锁骨钩板治疗致肩峰下撞击征预防 　　[摘 要] 目的：探讨锁骨钩板固定引起肩峰下撞击征的原因及预防方法。方法：用锁骨钩板内固定治疗肩锁关节脱位和锁骨远端骨折患者35 例，25例锁骨远端骨折者为 NeerⅡ型，10例肩锁关节脱位者为 TossyⅢ型。其中，11例手术中针对术后肩峰下撞击征的发生采取了必要的预防措施，具体措施为：对锁骨钩板钩端依据术前X片精确塑形，部分病例对放置部位（肩峰下间隙）进行清理。结果：术后随访4～18个月，中位数8个月，无失访。切口均一期愈合。术中未采取预防措施的24例患者，6例（25%）出现肩峰下撞击征。24例患者中18例锁骨远端骨折，4例出现肩部疼痛、外展活动受限，肩部撞击试验阳性；2 例出现肩部外展疼痛，肩部撞击试验阴性；取出内固定后，5例症状消失、1例症状缓解不明显，肩锁关节脱位，2例出现肩部疼痛、外展活动受限，肩部撞击试验阳性，取出内固定后症状消失。术中采取预防措施的11例患者未出现肩峰下撞击征。结论： 采用锁骨钩板内固定治疗肩锁关节脱位和锁骨远端骨折可引起肩峰下撞击征，术中应采取必要的预防措施。 　　[关键词] 锁骨钩板固定；肩峰下撞击征；预防 　　中图分类号：R684 文献标识码：A 文章编号：2055-5200（2014）01-054-03 　　Doi：10.11876/mimt201401014 　　Prevention？of？subacromial？impingement？syndrome？by？clavicular？hook？plate？fixation 　　XU Guo-hao，CHEN Fu-yang，ZHOU Jin-ming，YU Xian-yun. （Nanjing Pukou central Hospital Nanjing 211800） 　　[Abstract] Objective： To investigate the causes and prevention methods of subacromial impingement syndrome caused by clavicularhook plate fixation.Method：25 cases of type Ⅱneer distal clavicle fracture and 10 cases of type Ⅲ tossy acromioclavicular dislocation patients received clavicularhook plate internal fixation treatment.There are 35 cases （male 26， female 9， age 18-66， mean age 39） in all，and 11 cases moulded the plate accurately according to preoperation X-ray. Meanwhile subacromial space was cleared in some cases.Results：All the cases were followed up for 4 to 18 months with an average of 8 months.All healed by first intention.In the distal clavicle fracture，4 cases had shoulder pain，abduction limited，subacromial impingement，2 cases had shoulder pain.After removed the plate，5 cases were cured，1 case was still no cure.In the acromioclavicular dislocation，2 cases had houlder pain，abduction limited，subacromial impingement.After removed the plate，2 cases were cured.No subacromial impingement occur on the cases after subacromial space was cleared. Conclusions：Subacromial impingement syndrome can be caused by clavicularhook plate internal fixation treatment.Preventive actions shoulded be gived during the operation.