肩锁关节脱位闭合穿针固定定位导向器的研制和临床应用

Design and clinical application of the drilling guide in the treatment of acromioclavicular joint dislocation with closed reduction and Kirschner fixation

目的:通过研究一种方便于闭合复位经皮缝合内固定治疗肩锁关节脱位的辅助工具观察其临床应用效果。方法:自2008年6月至2009年12月,应用自行设计的肩锁关节脱位闭合穿针固定定位导向器穿针固定配以经皮修复肩锁韧带治疗肩锁关节脱位36例。其中男24例,女12例;年龄20～61岁,平均38.6岁。术前受伤时间3.5～72h,平均15.2h。均为TossyⅢ度肩锁关节脱位,无合并锁骨骨折。总结手术所用时间、术中出血量及临床效果。结果:术中未发生锁骨下神经、血管损伤,平均手术时间20min,平均出血量10ml,X线片示肩锁关节固定克氏针位置准确。术后6周取针,随访2～26个月,平均14.3个月,按Karlsson标准评定临床效果满意,优22例,良13例,差1例。结论:此方法简便易行,缩短了手术时间,费用低,且无手术切口瘢痕形成,保证了体表美观,属微创范围,便于推广应用。

Objective：To investigate a drilling guide in the treatment of acromioclavicular joint dislocation with closed reduction and Kirschner fixation and explore the therapeutic effect.Methods：From June 2008 to December 2009,36 patients with acromioclavicular joint dislocation（TossyⅢ） were treated with closed reduction and Kirschner fixation using a self-designed drilling guide as well as percutaneous repair of acromioclavicular joint.Among the patients,24 patients were male and 12 patients were female,ranging in age from 20 to 61 years,averaged 38.6 years.The duration from injury to operation ranged from 3.5 to 72 h,with a mean of 15.2 h.No clavicle fracture was found in all cases.The operative time,intra-operative bleeding and therapeutic effects were observed.Results：There were no complications including neurovascular problems.The mean operating time were 20 min,mean blood loss were about 10 ml.According to the observation of postoperative X-ray examination,all Kirschners in acromioclavicular joint were in place.All Kirschners were removed in 6 postoperative weeks.All the patients were followed up ranging from 2 to 26 months （averaged 14.3 months）.According to the Karlsson standard,22 patients got an excellent result,13 good and 1 poor.Conclusion：This method has following advantages：easy operation and fixation;minimum injuries to articular surface;and which would be widely used in clinical practice.