插入式与指突式锁骨钩钢板临床应用比较

Clinical comparison of two types of clavicular hook plates

目的对插入式与指突式锁骨钩钢板的临床应用进行分析、比较。方法自2000年9月至2003年10月采用锁骨钩钢板治疗肩锁关节脱位(TossyⅢ型)及锁骨外侧端骨折(NeerⅡ型)共计33例。其中使用插入式锁骨钩钢板(AO/ASIF)18例,使用指突式锁骨钩钢板(德国WALDEMARLINK公司)15例。结果插入式组平均切口长度7.6cm,平均手术时间28min;所有患者均获良好复位固定;术后无脱钩发生,但有1例发生肩峰下撞击。指突式组平均切口长度9.8cm,平均手术时间40min;术后发生脱钩1例,发生肩峰下撞击1例,肩峰部皮肤受钩端顶突痛2例。除1例脱钩者外,两组术后X线片复查均达满意复位,取出内固定后无再脱位,肩关节功能恢复良好。结论插入式锁骨钩钢板操作更简便,有利于手术时间和切口的最小化,理论的潜在并发症少,在肩锁关节脱位(TossyⅢ型)及锁骨外侧端骨折(NeerⅡ型)的治疗中更具优势。

Objective To analyze and compare clinical application of two types of clavicular hook plates. Methods From September 2000 to October 2003, 33 cases with acromioclavicular joint dislocation （Tossy Ⅲ ） or distal clavicle fractures （Neer Ⅱ ） were treated with insertion type （AO/ASIF） or knuckle-protruded type （WALDEMAR LINK） clavicular hook plates. The former one was used in 18 cases and the latter one in 15. Results In insertion type group, the average operation time was 28 minutes, with average incision length for 7.6 cm. All the cases got good reduction and fixation without any subluxation, except for one case suffering from impingement of the shoulder joint. In knuckle-protruded type group, the average operation time was 40 minutes, with an average incision length for 9.8 cm. After operation, one case lost hooking-up, one had born shoulder joint impingement, while another two suffered from skin pain at acromion caused by hook tip for a long time. Except for one case losing hooking-up, all cases of both groups achieved good recovery of function of shoulder joint and won satisfactory reduction without any redislocation after the implants being taken out. Conclusion Because of the advantages like convenient manipulation, short operation time, minor incisions and less potential complications, the insertion type clavicular hook plate is more suitable for cases with Tossy Ⅲ or Neer Ⅱ fractures.