锁骨钩钢板治疗NeerⅡ型锁骨外端骨折及TossyⅢ型肩锁关节脱位疗效分析

Clavicular hook plate in the treatment of TossyⅢtype acromioclavicular joint dislocation and NeerⅡtype distal clavicle fractures

目的探讨应用锁骨钩钢板治疗TossyⅢ型肩锁关节脱位及NeerⅡ型锁骨外端骨折,并对其疗效进行评估。方法笔者所在医院白2004年6月至2009年6月应用锁骨构钢板治疗35例肩锁关节脱位、锁骨外端骨折的病例,其中肩锁关节脱位21例,锁骨外端骨折14例。所有病例术后随访3～24个月。结果根据美国肩与肘协会评分系统对肩关节功能进行评价,优26例,占82%;良3例,占9%;一般3例,占9%。所有病例均未出现锁骨下血管和神经损伤、感染、内固定物松动脱出、骨不连和畸形愈合。结论锁骨钩钢板利用杠杆原理和钢板自身的强度对抗胸锁乳突肌的牵引力,可以避免内固定物体的松动脱出,由于术中不损伤肩锁关节面,能够避免或减少克氏针固定等经关节手术所造成的继发性创伤骨关节炎,该方法创伤小、固定牢固,能早期活动肩关节,是治疗TossyⅢ型肩锁关节脱位及NeerⅡ型锁骨外端骨折行之有效的方法 。

Objective To investigate the therapeutic efficacy of using clavicular hook plate while carrying out ORIF operation for treating Tossy Ⅱ type acromioclavicular joint dislocation and Neer Ⅱ type distal clavicle fractures. Methods 21 cases of Tossy Ⅲ type acromioclavieular dislocation and 14 cases of Neer Ⅱ type distal clavicle fractures accepted by our department from June of 2005 to June of 2009 were carried out the ORIF operation using clavicular hook plate. These patients were followed up for 3 -24 months after operation. Results Adopt American Shoulder and Elbow Surgeons＇ Form（ASES） to evaluate the patient＇s shoulder function after the operation. 35 cases including 26 excellent （82%）, 3 good （9%） and 3 average （9%）. Of all these patients have no injury of subclavian nerve and blood vessel,infection ,loose and prolapse of internal fixation devices and fracture nonunion and malunion. Conclusion Clavicular hook plate utilizes the lever principle and the intensity of plate itself to resist the traction force of sternomastoid muscle and avoid prolapse. Without damaging the acromioclavicular facet,it can avoid and reduce the traumatic arthritis caused by devices such as Kirschner wire etc. This method characterized by less trauma,firmly fixation and permitting early exercise is an effective method to cure Tossy Ⅲ type acremioclavicular dislocation and Neer Ⅱ type distal clavicle fractures.