带线锚钉重建喙锁韧带在手术治疗B、C型浮肩损伤中的临床意义.docVIP

熊健 遵义医学院硕士学位论文 装置取出后第 1、3 月，两组 CMS 肩关节功能评分 A 组平均分别为 86.4 分、88.4 分， B 组平均 83.3 分、84.8 分，t 检验表明两组存在统计学差异，A 组肩关节功能优于 B 组，特别是肩关节 ROM、疼痛改善方面好于 B 组。末次随访两组 Karlsson 肩锁关节 功能评分 A 组优良率 90.5%，B 组 79.2%，卡方检验提示两组比较有统计学意义，A 组优良率更高，患者肩外展、疼痛情况更优。所有患者均获得随访，无内固定松动、 脱钩、肩锁关节脱位、感染等情况发生。锁骨上神经损伤病例 8 例，随访半年后症状 均改善或消失。B 组 2 例出现尖峰下撞击综合征，内固定装置取出后症状好转。 结论：浮肩损伤破坏了上肩胛带复合体的稳定性，肩胛颈联合锁骨或肩锁关节内固 定恢复了肩关节稳定性，手术治疗是有必要的。带线锚钉重建喙锁韧带具有良好的生 物力学模式，术后促进了肩关节功能恢复，结合联合内固定是一种治疗浮肩损伤的较 好方法。 关键词：浮肩损伤；肩胛颈骨折；锁骨远端骨折；肩锁关节脱位；喙锁韧带；锚钉； 钩钢板 3 万方数据 熊健 遵义医学院硕士学位论文 The clinical significance of coracoclavicular ligament reconstructed with wire anchor in surgical treatment of type B and C floating shoulder injuries Objective:To analysis the treatment effect of coracoclavicular ligament reconstructed with wire anchor in internal fixation of the floating shoulder injury. Methods：Retrospective studies of patients that treated from January 2006 to January 2014 with type B and C floating shoulder injuries that had internal fixed of ipsilateral scapular neck and clavicle or acromioclavicular joint were divided into group A that had coracoclavicular ligament reconstructed with wire anchor and group B none.In group A there were 9 cases patients suffered with Neer Ⅱ type distal clavicle fracture and 12 cases were Tossy Ⅲ type - Ⅴ acromioclavicular joint dislocation, and the ipsilateral scapular fracture included 5Ⅰtype cases, 2 Ⅱ type cases, 14 Ⅲ type cases。In group B, 11 cases were distal Neer Ⅱ type clavicle fracture and 13 cases were Tossy Ⅲ type - Ⅴ acromioclavicular joint dislocation, and the ipsilateral scapular fracture included 8Ⅰtype cases, 2 Ⅱ type cases, 14 Ⅲ type cases. Patients in group A removed fixation 3～5month postoperation, group B was 8～12month. The operation time , blood loss, postoperative complications, coracoclavicular distances, opstoperative efficacy of two groups were recoeded and analysised. The outcomes were assessed according to Constant-Murley shoulder score and Karlsson criteria. Results：The operation time o