锁骨钩钢板内固定术后并发症分析与防治对策

Complications of the clavicle hook plate and corresponding managements

目的分析锁骨钩钢板治疗急性锁骨远端骨折和肩锁关节脱位的并发症发生原因，探讨减少和避免并发症的对策。方法2006年5月至2009年5月，79例接受锁骨钩钢板固定治疗的患者中78例再次手术取出钩钢板。40例在取出钩钢板时接受CT检查，以观察肩峰下骨侵蚀的形态，其中7例在3个月再行CT检查，以了解其转归。末次随访时对患肩功能进行Constant评分。结果所有病例均获得随访，随访时间12-30个月，平均13．2个月。锁骨远端骨折和肩锁关节脱位患者钩钢板存留时间分别平均为8．3个月和7．2个月，末次随访Constant评分分别平均为92分和95分。78例患者出现8种（105例次）并发症，总的并发症发生率98．7％。与锁骨钩钢板作用特点有关的并发症88例次（83．8％），医原性并发症12例次（11-4％），与锁骨钩钢板自身缺陷有关的并发症3例次（2．9％），原发疾病治疗中固有的并发症2例（1．9％）。结论锁骨钩钢板的并发症发生率高。绝大多数并发症的成因与其自身作用特点有关，难以避免；可通过选用合适的内植物、提高患者依从性等减轻其严重程度。应告知患者对肩峰下骨侵蚀转归仍不清楚，以免产生医疗纠纷。医原性并发症通过严格掌握适应证和提高手术技术可避免。年轻和老年患者应慎用。设计上有改进的必要，且须尽早移除。

Object To analyze reasons of complications induced by the clavicle hook plate in treat- ment of acute distal clavicle fractures and acute acromioclavicular joint dislocations, and to investigate corre- sponding solutions. Methods Seventy nine clavicle hook plates were facilitated in the treatment of acute distal clavicle fractures （47 cases） and acute high grade acromioclavicular joint dislocations （32 cases） from May 2006 to May 2009. There were 51 males and 28 females, with an average age of 42.6 years（range, 15 to 78 years）. Seventy eight patients underwent plate removal operation. Forty patients agreed to accept the CT examination to evaluate the acromion erosion around the plates. Among them, 7 patients received further CT examination 3 months after the removal surgery. The shoulder function was evaluated by the constant scores at the final follow-up. Results All patients were followed up for at least one year （range, 12 to 30 months）. The mean duration for retaining the hook plate was 8.3 months with the mean Constant scores 92 points in the acute distal clavicle group; 7.2 months with the mean Constant scores 95 points in the acute acromio- clavicular joint dislocation group. There were 8 kinds, totally 105 complications happened in 78 patients （98.7%）. The complications were classified into four groups： （1） Due to the specific working mechanism of the plate（88/105, 83.8%）;（2） Due to the iatrogenic errors（12/105, 11.4 %）;（3） Due to insufficiency design of the plate（3/105, 2.9%）;（4） Due to the etiology of the injury itself（2/105, 1.9%）. Conclusion The com- plication rate is unexpected higher. Most complications are unavoidable due to specific working mechanism of the plate. The patients should be well informed about this preoperatively in order to avoid the possible le- gal trouble. The iatrogenic errors can be avoided with proper indications and improved surgical techniques. The design of the plate needs to be improved, and the hook plate should be removed as early as possible.