锁骨钩钢板固定治疗Ⅲ度肩锁关节脱位

Surgical treatment of degree Ⅲ acromioclavicular joint dislocation using the clavicular hook plate

目的 探讨AO锁骨钩钢板 (clavicularhook -plate ,CHP)治疗Ⅲ度肩锁关节脱位的疗效。 方法 4 5例患者资料来源于北京首都医科大学附属朝阳医院骨科 (2 4例 )和北京潞河医院骨科 (2 1例 )。均为AllmanⅢ度肩锁关节完全性脱位 ,应用CHP固定治疗。所有病例均直接修复断裂的肩锁韧带 ,其中 19例直接修复断裂的喙锁韧带 ,2 6例用喙肩韧带代替重建无法直接修复的喙锁韧带。 结果 获随访 4 1例 ,随访时间 3～ 4 7个月 ,平均 2 6个月。术后 15～ 2 0d ,肩关节活动基本正常。患者恢复工作和体力劳动为术后 2～ 4个月 ,平均 3个月。取出CHP时间为 3～ 10个月 ,平均 5个月。无钢板断裂、螺钉松动和再脱位。按Karlsson疗效评价标准 ,优占 80 .5 % (33 4 1) ,良占 14 .6 % (6 4 1) ,差占 4 .9% (2 4 1)。优良率达 95 .1% (39 4 1)。 结论 CHP治疗Ⅲ度肩锁关节脱位 ,可早期活动肩关节 ,关节功能恢复快 ,疗效满意。

Objective To study the curative effect of surgical treatment of degree Ⅲ acromioclavicular joint dislocation using the clavicular hook-plate (CHP). Methods Twenty-four patients were from Beijing Chaoyang Hospital, Capital University of Medical Sciences, 21 patients were from Beijing Luhe Hospital. The CHP fixation was used to treat 45 cases of Allman degree Ⅲ acromioclavicularjoint dislocation. The broken acromioclavicular ligament was repaired directly in all cases. The broken coracoclavicular ligament was repaired directly in 19 cases and reconstructed with coracoacromial ligament in 26 cases. Results Out of 45 cases,41 cases had been followed up for 3-47 months (average 26 months). All the dislocated acromioclavicular joints returned to normal level 15-20 days after the treatment. All the patients could do their work and manual labour after a mean period of 3 months (2-4 months). There was no redislocation, plate breakage or screw loosening after CHP was taken away in 3-10 months (average 5 months). Excellent rate was 80.5% (33/41) , effective rate 14.6% (6/41),poor rate 4.9% (2/41), excellent plus effective rate 95.1%(39/41)according to Karlsson result evaluation. Conclusions The acromioclavicular joint can exercise earlier and recovered quickly when degree Ⅲ dislocated acromioclavicular joint is treated with CHP. The curative effect has been proved satisfactory.