锁骨钩接骨板治疗锁骨远端骨折和肩锁关节脱位(附15例病例报告)

The use of a hook-plate in the management of distal clavicle fracture and arcomioclavicular dislocation. Report of fifteen cases

目的观察锁骨钩接骨板治疗锁骨远端骨折(NeerⅡ)和肩锁关节脱位(TossyⅢ)的临床效果。方法近年应用AO锁骨钩钢板或形状记忆合金锁骨钩锯齿环抱内固定器治疗NeerⅡ型锁骨远端骨折7例,TossyⅢ度肩锁关节脱位8例。其中男13例,女2例;平均年龄43岁(32～48岁)。术后患侧上肢颈腕吊带悬吊,早期功能锻炼。结果平均随访16.4个月(2～32个月)。锁骨远端骨折在术后4～8周均愈合,未发生延迟愈合和不愈合;肩锁关节脱位未再发生移位,未发现伤口感染、内固定物断裂、肩部撞击等并发症。所有患者均重返工作。肩关节的功能用L’Insalata评分和Constant评分评估,健侧肩做对照。结果示锁骨远端骨折患者患肩的功能与健侧无显著性差异(>0.05);肩锁关节脱位患者患肩的功能与健侧无显著性差异(>0.05)。仅有一患者因不配合功能锻炼造成患肩外展受限。本组9例疗效为优,5例疗效为良,1例疗效一般。优良率为93%。结论锁骨钩接骨板是治疗锁骨远端骨折(NeerⅡ)和肩锁关节脱位(TossyⅢ)的一种良好选择。

Objective To investigate the clinical effect of a clavicular hook-plate in the management of distal clavicle fracture （NeerⅡ ） and acromioclavicular dislocation （TossyⅢ）. Methods From June 2000 to August 2003, seven patients presented with distal clavicle fracture （Neer Ⅱ ） and eight with acromioclavicular dislocation （TossyⅢ） were treated with AO hook-plate or shape-memory clavicular hook sawtootharm embracing fixer. Of the 15 cases, 13 were males and 2 were females. The mean age was 43 years （range ,32 - 48years）. A sling was used after operation for immobilization but early functional exercises were encouraged. Results The average length of follow-up was 16.4 months （range, 2-32 months）. All the patients with distal clavicle fracture achieved osseous union within 4 - 8 weeks, The complications such as delayed union, ununion, redislocation of the acromioclavicular joint, wound infection, breakage of fixer, impin- gement syndrome were not found. All patients returned to the previous work. Shoulder Symptoms and function were assessed with L＇ Insalata scoring system and Constant scoring system. Both shoulders were assessed in each cases, and the normal shoulders were used as the control group, There was no significant difference between the injuried shoulder and the normal one （P〉0.05）. Only one patient suffered from limitation of abduction due to inappropriate exercises. Results were good to excellent in 93% of cases, in which 9 cases were excellent, 5 good, 1 fair. Conclusion The clavicular hoot- plate appear to be a useful device to treat distal clavicle fracture （Neer Ⅱ ）and acromioclavicular dislocation （TossyⅢ）.