锁骨钩钢板与交叉克氏针张力带治疗锁骨远端骨折脱位的疗效比较

Comparative Study of the Treatments of Distal Clavicle Fractures and/or Acromioclavicular Joint Dislocation by Clavicular Hook Plate or Tension Band Fixation

目的比较AO锁骨钩钢板（clavicular hook-plate，CHP）与交叉克氏针张力带（tension band fixation，TBF）内固定治疗锁骨远端骨折（NeerⅡ型）与肩锁关节脱位（TossyⅢ型）的疗效，评估CHP在治疗锁骨远端骨折与肩锁关节脱位的临床疗效。方法回顾性分析比较TBF治疗锁骨远端骨折与肩锁关节脱位31例与CHP治疗28例的临床效果的差异。结果59例患者均得到随访11～31个月，平均15．6个月，所有病例均骨性愈合，无肩锁关节再脱位发生，CHP组无内固定松动与断裂发生，TBF组有2例发生克氏针旋转滑脱、钢丝松脱。按Lazzcano评分，CHP与TBF组优起率分别为96．34％和74．19％，经X^2检验，P〈0．05，并发症发生率分别为3，57％和29．32％，经X^2，检验P〈0．05，差别有统计学意义，认为CHP组较TBF组临床治疗效果优良率高而并发症发生率低。结论CHP治疗锁骨远端骨折并肩锁关节脱位具有操作简单，固定可靠，不损伤关节面，可早期关节功能康复锻炼、恢复快、疗效确切等优点，是理想的锁骨远端骨折（NeerⅡ型）与肩锁关节脱位（TossyⅢ型）的临床治疗方法。

Objective To evaluate the clinical effects nf Clavicular hook-plate（CHP） in treatment of distal clavicle fractures（Neer degree Ⅱ） and/or acromioclavicular joint dislocation （Tossy degree Ⅲ） in comparison with tension band fixation （TBF）. Methods A retrospective analysis was done to compare the effects and complications between the treatments of distal clavicle fractures and/or acromioclavicular joint dislocation by CHP （n = 28） or TBF （n = 31）. Results Fifty-eight eases were followed up for 11 to 31 months, with an average of 18.6 months, All the cases were healed no redisloeation was observed, either breakage or loosening of the clavicle hook-plate was not observed in CHP group, only 2 cases were observed in TBF group. According to Lazzeano＇s criterian, the excellent and fine rates of the clinical outcomes of the two groups were, 96.43% and 74.19% （P 〈 0.05）, and the complications rates were 3.57% and 29.32% （P 〈 0.05） respectively, therapeutic outcomes and complications of the CHP groups were obviously better than TBF groups. Conclusions Treatment of distal clavicle fractures and/or acromioclavicular joint dislocation with CHP has the advantages of easy operation and reliable fixation and no invasion of article suffaee, it also permits the patients to start functional exereises earlier and recovered more quickly. It is an ideal surgical method.