锁骨钩钢板内固定治疗肩锁关节脱位与锁骨外侧端骨折失败原因分析及对策

Analysis of common causes and solution strategy of unsuccessful clavicular hook plate implantation for treatment of acromioclavicular joint dislocation and lateral clavicle fractures

目的探讨锁骨钩钢板内固定治疗肩锁关节脱位与锁骨外侧端骨折失败的原因与对策。方法自2006-06—2011-12应用锁骨钩钢板内固定治疗肩锁关节脱位与锁骨外侧端骨折283例,失败27例,失败率9.54%,对其相关因素进行分析。结果医源性失误6例,占22.2%;螺钉松动、钢板折弯、锁骨钩断裂4例,占14.8%;肩峰磨损骨溶解、肩峰撞击、肩袖损伤、肩部疼痛、肩关节活动受限17例,占63.0%。结论熟悉肩锁关节解剖、锁骨钩钢板结构原理,术中清楚显露锁骨后侧部分肩峰骨质,使锁骨钩钢板确实插入肩峰下方,能有效减少医源性失误;对于肩峰撞击、骨溶解等结构性并发症,可适当提前取出内固定;或采用Endobutton带袢钢板固定,可避免肩峰下内容物,有效减少肩峰撞击、磨损、肩袖损伤等并发症。

Objective To investigate the common causes of unsuccessful clavicular hook plate implantation for treatment of acromioclavicular joint dislocation and lateral clavicle fractures, and provide appropriate solution strategy. Methods From Jun. 2006 to Dec. 2011 hook plate was used in 283 cases, and 27 cases failed, with failure rate 9.54%. The related failure factors were analysed. Results The failure cases included 6 iatrogenic errors(22.2%), 4 screws loosening, plate bending and breakage(14.8%), 17 osteolysis by wearing of acromion, subacromial impingement, rotator cuff lesion, shoulder pain, limitation of shoulder mobility(63.0%). Conclusion To strengthen theory study, to be familiar with the anatomy of acromioclavicular joint,to understand the structure and principle of the clavicular hook plate deeply, to have a good exposure of the acromion so that the hook plate could insert into the subacromion space accurately, all above measures can reduce the iatrogenic error effectively. Removing the plate ahead of time properly can reduce the structured complications such as subacromial impingement and osteolysis. Besides, the emerging endobutton technique, which is a kind of elastic fixation, can avoid interfering the subacromion and reduce subacromial impingement and wearing of acromion and rotator cuff lesion effectively.