新鲜肩锁关节脱位及锁骨远端骨折的微创治疗

Minimally invasive treatment for fresh acromioclavicular dislocation and the distal clavicle fracture

目的:探索新鲜肩锁关节脱位和锁骨远端骨折的微创治疗方法。方法:采用20套人肩部骨骼标本和10例尸体标本进行基础研究,并用超声引导,在活体上测量、设计,确定了喙突尖至锁骨锥状韧带结节后方骨突连线同锁骨中轴交点的定位方法。2001年1月至2010年1月,采用体表标志定位,微创内固定手术方法,对127例新鲜肩锁关节脱位及锁骨远端骨折进行治疗,男97例,女30例;年龄19～56岁,平均43岁。新鲜肩锁关节脱位93例,根据Rockwood分型,Ⅲ型67例,Ⅳ型11例,Ⅴ型15例;新鲜锁骨远端骨折34例,均合并喙锁韧带断裂。手术时间在伤后1～8d,疗效评估采用美国加州洛杉矶大学肩关节评分系统(UCLA)。结果:全部病例手术固定后,早期均完全复位。随访113例,时间13～15个月,平均14个月。9例螺钉在30d内出现轻度松动,位置仍可接受,功能恢复良好。7例并发肩周炎,半年后恢复。UCLA肩关节评分总平均分(32.0±4.7)分。优87例,良20例,可6例。结论:本方法具有创伤微小、费用低廉的优点,值得在临床推广使用。

Objective：To explore the minimally invasive treatment for fresh acromioclavicular dislocation and the distal clavicle fracture.Methods：Thirty skeletons of human shoulder were measured and compared,and the normal data on healthy people were measured with the help of ultrasound-guided.So the invasion point was located at the cross between subclavian axis and the line from coracoid tip to apophysis behind cone ligament node.From January 2001 to January 2010,127 patients with fresh acromioclavicular dislocation and distal clavicle fracture were treated with minimally invasive internal fixation after locating the invasive point at the body surface.Among the patients,97 patients were male and 30 patients were female,ranging in age from 19 to 56 years,with an average of 43 years.According to Rockwood classification,among 93 patients with fresh acromioclavicular dislocation,67 patients were type Ⅲ,11 patients were type Ⅳ and 15 patients were type V.All the 34 patients with distal clavicle fractures were associated with coracoclavicular ligament broken.The duration from injury to operation ranged from 1 to 8 days.The therapeutic effects were evaluated by using the of shoulder scoring system,University of California（UCLA）.Results：After the minimally invasive treatment,all the patients had completely reduction at early time.One hundred and thirteen patients were followed up,and the duration ranged from 13 to 15 months,averaged 14 months.Nine patients had screw loose slightly within 30 days,but the reductions and functions were acceptable.Seven patients had complications of frozen shoulder and recovered in 6 months.The average UCLA shoulder score was （32.0±4.7）,and 87 patients got an excellent result,20 good and 6 fair.Conclusion：This minimally invasive treatment has advantages such as little trauma and low cost,which is worthy of clinical applications.