锁骨钩板治疗锁骨外侧端骨折及肩锁关节脱位2年随访分析

Analysis of Two Year Follow- up of Clavicular Hook Plate in the Treatment of Distal Clavicular Fracture and Acromioclavicular Joint Dislocation

目的探讨锁骨钩板治疗肩锁关节脱位及锁骨外侧端骨折的疗效和并发症情况,为手术方案的制定提供指导。方法选取我科2010年11月至2013年7月间收治的37例锁骨外侧端骨折患者(A)及32例肩锁关节脱位患者(B),均采用肩锁钩板固定,术中视情况选择钢丝捆扎及韧带修复,术后随访2年,行Constant-Murley评分,并观察并发症发生情况,行统计学分析。结果所有患者获得随访,术后3个月Constant-Murley评分优良率分别为A组[83.8%(31/37)],B组[84.4%(27/32)];其差异无统计学意义(P>0.05);术后2年为A组[86.5%(32/37)],B组[93.8%(30/32)],其差异有统计学意义(P<0.05)。并发症发生率A组[18.9%(7/37)],B组[15.6%(5/32)],P>0.05。在发生并发症的患者中发现肩锁关节骨化10例,其中A组6例,B组4例,肩锁关节原有骨关节病5例,其中A组3例,B组2例。结论肩锁钩板是治疗锁骨外侧端骨折和肩锁关节脱位的有效术式,但肩锁关节脱位优于锁骨外侧端骨折,其原因主要与肩锁关节骨化和骨关节病有关。

Objective To investigate the therapeutic effect and complications of clavicular hook plate in the treatment of dislocation of acromioclavicular joint and distal clavicular fracture to provide guidance for making operation scheme. Methods 37 patients suffering from distal clavicular fracture（ A） and 32 patients suffering from dislocation of acromioclavicular joint（ B） admitted in our department from November,2010 to July,2013 were treated by using clavicular hook plate fixation,and in the operation wire binding and ligament repair may be used which depended on the situation. The patients were given a postoperative follow- up for 2 years; a Constant- Murley score was offered,the occurrence of complications were observed and the statistical analysis was carried out. Results All patients were followed up,and after 3 months,excellent and good rate of Constant- Murley score was 83. 8%（ 31 /37） for group A and 84. 4%（ 27 /32） for group B; the difference was not statistically significant（ P〉0. 05）,2 years after the operation,the statistics became 86. 5%（ 32 /37） for group A and 93. 8%（ 30 /32） for group B,with statistically significant difference（ P〈0. 05）. The complication rate of group A was 18. 9%（ 7 /37）,and that of group B was 15. 6%（ 5 /32）,（ P〉0. 05）. Among patients suffering from the complications,10 patients suffered from acromioclavicular joint ossification with 6 cases in group A and 4 cases in group B,5 patients suffered from the original of acromioclavicular joint osteoarthritis,with 3 cases in group A and 2 cases in group B. Conclusion Clavicular hook plate is an effective surgical treatment of distal clavicular fracture and acromioclavicular joint dislocation,but the latter is better than the former,and the main reasons are related to the acromioclavicular joint ossification and osteoarthropathy.