改良闭合复位经皮克氏针内固定治疗新鲜肩锁关节脱位

Modified method of a Kirschner pin penetrating into shoulder peak via skin and fixing after close reduction for the treatment of fresh acromioclavicular dislocation

目的：探讨改良闭合复位经皮克氏针内固定治疗新鲜肩锁关节脱位的疗效.方法：新鲜肩锁关节脱位患者26例,男21例,女5例;年龄22～53岁,平均33.1岁.TossyⅡ型6例,Ⅲ型20例.采用改良闭合复位经皮克氏针内固定治疗,手法复位后用1枚直径2 mm的克氏针通过进针定位器穿入肩峰并固定肩锁关节,术后患侧上肢三角巾悬吊4周,3个月内患肢避免重体力劳动,3个月后拔针.结果：3例术后因针尾顶破皮肤致针尾部位感染而于4周后拔除克氏针,1例3个月复查时克氏针轻度折弯,但肩锁关节未见脱位.所有病例随访6～12个月,平均9个月.疗效按Karlsson分级：A级25例,B级1例.结论：改良闭合复位经皮克氏针内固定治疗新鲜肩锁关节脱位简单易行,创伤小,疗效好,费用低,无切口感染及瘢痕障碍等并发症.

Objective：To discuss therapeutic effects of modified method of a Kirschner pin penetrating into shoulder peak via skin and fixing after closed reduction for the treatment of fresh acromioclavicular dislocation. Methods：Twenty-six patients with fresh acromioclavicular dislocation concluded 21 males and 5 females with an average age of 33.1 years ranging from 22 to 53 years. There were 6 cases of Tossy II and 20 of Tossy III. All patients were treated by modified method of Kirschner pin penetrating into shoulder peak via skin and fixing after closed reduction. The acromioclavicular joint was fixed with a Kirschner pin penetrated into shoulder peak through positioner after closed reduction. After operation, the upper limb was suspended by triangular bandage for 4 weeks and heavy manual labour was not permitted for 3 months and the pin was removed after 3 months. Results：All cases were followed up with an average of 9 months （ranging from 6 to 12 months）. Kirschner pins of 3 cases were removed after 4 weeks because the skin located at Kirschner pins tail position were infected. One Kirschner pin was curved slightly in 3 months, but no dislocation was found. The therapeutic effects were ranked according to the standard of Karlsson,25 cases were grade A, and 1 case was grade B. Conclusion：The method is characterized by simple to operate with minimal trauma, good efficacy,the little cost. No incision infection and cicatricle occur.