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锁骨钩钢板结合锚钉治疗肩锁关节脱位22例

三种内固定方法治疗肩锁关节脱位的疗效分析

钢丝联合重建钢板治疗分离性肩锁关节脱位的近期疗效观察

【摘要】　目的　总结采用钢丝联合重建钢板治疗分离性肩锁关节脱位的临床近期疗效。　方法　2008年2月-2010年11月，采用钢丝联合重建钢板治疗分离性肩锁关节脱位4例。男2例，女2例；年龄24~45岁，平均年龄33.5岁。肩锁关节均呈分离性脱位，分离距离4.0~6.5 cm，平均5.2 cm。受伤至手术时间2~4 d。治疗后参照Karlsson评价标准，根据疼痛程度、上肢肌力、肩部活动度及X线片检查中肩锁关节间隙进行疗效评定。　结果　3例获随诊，随访时间2~12个月，平均5.6个月。X线片示肩锁关节位置正常，无钢板螺钉断裂、松动。术后2个月，按Karlsson标准评价疗效，获优1例，良2例。　结论　钢丝联合重建钢板治疗分离性肩锁关节脱位固定牢固，符合生物力学要求，可早期进行功能锻炼，获得良好的临床效果。

EyresⅢA型喙突骨折的手术治疗

目的 总结Eyres ⅢA型喙突骨折手术治疗方法及效果。 方法 2010年8月－2014年8月，采用锁骨钩钢板固定肩关节联合喙突骨折解剖复位后2枚空心钉固定治疗4例Eyres ⅢA型喙突骨折患者。男3例，女1例；年龄36～41岁，平均39岁。致伤原因：交通事故伤3例，机器伤1例。伤后至入院时间2～12 h，平均6 h。 结果 术后患者切口均Ⅰ期愈合，无感染、皮肤坏死等术后早期并发症发生。4例均获随访12个月。术后4个月取出锁骨钩钢板，保留空心钉。术后8个月CT示骨折完全愈合。随访期间无肩关节再脱位，内固定物松动、断裂，继发骨折等发生。术后12个月根据Neer肩关节功能评分标准评分为83～87分，平均85分。 结论 对于Eyres ⅢA型喙突骨折，采用锁骨钩钢板固定肩关节联合喙突骨折解剖复位后2枚空心钉固定可行且疗效满意。

Allman Ⅲ度肩锁关节脱位的Dewar手术疗效分析

EFFECTIVENESS COMPARISON OF CORACOCLAVICULAR LIGAMENT RECONSTRUCTION BETWEEN BY AUTOLOGOUS AND ALLOGENEIC TENDON GRAFTS COMBINED WITH HOOK PLATE FIXATION FOR TREATING ACROMIOCLAVICULAR JOINT DISLOCATION

ObjectiveTo compare the effectiveness of coracoclavicular ligament reconstruction between by using autologous plantaris tendon graft combined with hook plate fixation and allogeneic tendon graft combined with hook plate fixation for treating acromiocavicular joint dislocation. MethodsThirty-three patients with acromioclavicular joint dislocation who accorded with the inclusion criteria between January 2013 and June 2014 were assigned into 2 groups. The patients were treated with autologous plantaris tendon graft combined with hook plate fixation in group A (n=17), and with allogeneic tendon graft combined with hook plate fixation in group B (n=16). Thirteen-one patients was followed up more than 12 months (15 in group A and 16 in group B). There was no significant difference in gender, age, cause of injury, sides, time between injury and surgery, and type of dislocation (P>0.05). The assessments included operation time, hospitalization time, hospitalization expenses, shoulder range of motion, gap of acromioclavicular, Constant-Murley scores, and visual analogue scale (VAS) for pain. ResultsThe operation time of group A was significantly longer than that of group B, and the hospitalization expense was significantly lower than that of group B (P<0.05). There was no significant difference in hospitalization time (t=1.046, P=0.316). The incisions healed by first intention, and hook plate was removed after 3 months. The mean follow-up time was 21.3 months (range, 19-34 months) in group A and was 23.7 months (range, 18-37 months) in group B. X-ray examination showed no osteolysis. There was no significant difference in gap of acromiocavicular between 2 groups at preoperation, 1 week after operation, and last follow-up (P>0.05). No redislocation of acromioclavicular joint and rejection reaction occurred during follow-up. At last follow-up, there was no significant difference in shoulder range of motion, Constant-Murley score, and VAS score between 2 groups (P>0.05). ConclusionCoracoclavicular ligament reconstruction by autologous plantaris tendon or allogeneic tendon graft combined with hook plate fixation for the treatment of acromioclavicular joint dislocation can achieve good effectiveness. The appropriate treatment should be chosen according to the patient's economic situation.

Open reduction and internal fixation in treatment of four cases of bipolar clavicle dislocations

Objective To summarize the method and effectiveness of open reduction and internal fixation in the treatment of 4 cases of bipolar clavicle dislocations. Methods Between June 2017 and June 2022, 4 patients with bipolar clavicle dislocations were admitted. There were 3 males and 1 female. The age ranged from 27 to 63 years, with an average age of 45 years. There were 2 cases of crushing injury of mine car, 1 case of traffic accident injury, and 1 case of heavy object injury. The time from injury to operation was 3-7 days, with an average of 5.0 days. The sternoclavicular joint dislocations were classified as Grade Ⅱ in 1 case and type Ⅲ in 3 cases, and anterior dislocation in 3 cases and posterior dislocation in 1 case. The acromioclavicular joint dislocations were classified as Tossy type Ⅱ in 2 cases and type Ⅲ in 2 cases. After open reduction, the sternoclavicular joint and acromioclavicular joint were fixed with lateral malleolus locking titanium plate and clavicular hook plate, respectively. ResultsAll operations were successfully completed without vascular or nerve injury. All incisions healed by first intention. All patients were followed up 12-18 months, with an average of 14 months. At last follow-up, the shoulder joint functions were rated as excellent in 3 cases and good in 1 case according to Rockwood score. During follow-up, there was no loosening of internal fixator or fracture. The internal fixators were removed in all patients at 5-7 months after operation (mean, 6 months), and no re-dislocation occurred after removal. Conclusion For bipolar clavicle dislocation, open reduction combined with lateral malleolus locking titanium plate fixation of the sternoclavicular joint and clavicle hook plate fixation of the acromioclavicular joint can achieve good effectiveness. It has the advantages of simple operation, high safety, firm fixation, and fewer complications, and the shoulder function recovers well.

锁骨钩钢板的临床应用及并发症分析

目的 总结以锁骨钩钢板内固定治疗Neer Ⅱ型锁骨远端骨折和Tossy Ⅲ型肩锁关节脱位的临床应用效果及并发症。 方法 2005 年8 月－ 2010 年2 月，以锁骨钩钢板内固定治疗Neer Ⅱ型锁骨远端骨折20 例和TossyⅢ型肩锁关节脱位28 例，对临床应用效果及术后并发症进行回顾性分析。其中男30 例，女18 例；年龄20 ～ 64 岁，平均33.5 岁。交通事故伤36 例，坠落伤12 例。受伤至手术时间为2 ～ 10 d，平均4.5 d。 结果 术后所有患者切口均Ⅰ期愈合。48 例均获随访，随访时间6 ～ 24 个月，平均13.6 个月。术后发生脱钩2 例、断钩1 例、锁骨应力性骨折1 例、异位骨化1 例、锁骨上皮神经损伤1 例、肩部出现异响不适3 例，均经再手术或对症处理治愈或好转。按洛杉矶加利福尼亚大学（UCLA）肩关节等级评分评定疗效，获优15 例，良27 例，可6 例，优良率87.5%。38 例于术后9 ～ 24 个月取出内固定物，未出现再骨折或肩锁关节再脱位情况。 结论 以锁骨钩钢板内固定治疗Neer Ⅱ型锁骨远端骨折和Tossy Ⅲ型肩锁关节脱位疗效良好，但需注意处理其并发症。

锁骨钩钢板治疗Ⅲ度肩锁关节脱位

喙肩韧带重建喙锁韧带治疗肩锁关节Ⅲ度脱位