锁骨远端骨折、肩锁关节脱位的手术及康复治疗

Operation and Rehabilitative Treatment of Distal Clavicle Fractures and Acromioclavicular Dislocation

目的：分析应用Wolet钩钢板治疗NeerⅡ型锁骨远端骨折、TossyⅢ型肩锁关节脱位及康复过程中出现的问题,寻求解决办法。方法：选择南京大学医学院附属鼓楼医院骨科53例锁骨远端骨折及肩锁关节脱位患者,其中NeerⅡ型锁骨骨折29例,TossyⅢ型肩锁关节脱位24例。将锁骨远端骨折及肩锁关节脱位复位,应用Wolet钩钢板钢板固定,术后开始分阶段进行康复训练及物理治疗。结果：术后随访6个月~2年8个月,平均15个月。参照Karlsson标准评价疗效,优41例,可12例,差0例。随访的X线片示平均骨折愈合时间约12周,未见骨折不愈合、肩锁关节半脱位、钢板断裂。有4例出现螺钉松动、钢板移位,其中1例伴有脱钩现象,1例钩尖穿破皮肤致感染。结论：应用Wolet钩钢板、结合康复训练治疗锁骨远端骨折及肩锁关节脱位,疗效确切;但术中操作不当、术后康复训练不当将引起并发症。

Objective：To explore the effect of Wolet plate on distal clavicle fractures of Neer Ⅱ type and acromioclavicular dislocation of Tossy Ⅲ type.Methods：Twenty-nine patients with distal clavicle fractures of Neer Ⅱ type and 24 patients with acromioclavicular dislocation of Tossy Ⅲ type from Gulou Hospital affiliated to Nanjing medical university were enrolled in the present study.Distal clavicle fractures and acromioclavicular dislocation received the treatment of reposition and fixation by Wolet plate.All patients received rehabilitation training and physic exercise.Results：The patients were followed up for 6 months to 30 months,15 months averagely.According to Karlsson effective standard,excellent effect were observed in 41 cases and good effect in 13 cases.X-ray showed that average duration of fracture union was 12 weeks.Fracture disunion,acromioclavicular subluxation,and plate disrupt were observed in none patients.Screw cinch and plate shifting were observed in 4 cases,plate release in 1 case,and infection in 1 case.Conclusion：Wolt plate combined with rehabilitation training and physic exercise is effective in treating distal clavicle fractures and acromioclavicular dislocation.