锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位

Clavicular hook plate combined with hollow screw fixation in the treatment of acromial fracture accompanied with acromioclavicular joint dislocation

目的探讨锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位的临床疗效。方法回顾性分析本院骨科自2008年1月至2018年12月收治的15例肩峰骨折合并肩锁关节脱位患者的临床资料,其中男13例、女2例;患者年龄范围18~60岁,平均年龄(34.67±15.53)岁;致伤原因:交通伤8例,摔伤2例,坠落伤3例,运动伤2例。肩峰骨折分型,OgawaⅠ型5例,OgawaⅡ型10例;肩锁关节脱位分型,TossyⅡ型7例,TossyⅢ型8例。治疗方案均为肩峰骨折采用切开复位空心钉内固定治疗,肩锁关节脱位采用切开复位锁骨钩钢板内固定治疗。术后1年根据患者患侧肩关节活动范围及肩关节Constant-Murely评分对患者进行功能评价。结果所有患者均获得至少1年以上随访,平均随访时间(21.60±9.83)个月,术后患者切口均一期愈合,未发生伤口感染、骨折愈合不良、骨折脱位复位丢失、肩峰下撞击、钢板螺钉松动等情况。术后1年肩关节活动范围:外展90°~145°,平均(114.00±19.29)°;上举100°~180°,平均(136.67±27.10)°;后伸30°~60°,平均(42.00±10.66)°;外旋30°~45°,平均(38.00±6.76)°。术后1年Constant-Murely评分70~96分,平均(85.73±7.26)分,优5例,良7例,可3例,优良率80%。结论锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位操作安全、简单、疗效确切,术后患者功能恢复满意,值得在临床中应用。

Background Acromial fracture is a not common type of fracture,and acromial fracture combined with acromioclavicular joint dislocation is even more rare,which belongs to one of the superior shoulder suspensory complex(SSSC)lesions.Studies have shown that the clinical prognosis of this injury is often poor.At present,the studies of the injury are too few to determine the best treatment option.Objective To investigate the clinical efficacy of clavicular hook plate combined with hollow screw fixation in the treatment of acromial fracture accompanied with acromioclavicular joint dislocation.Methods From January 2008 to December 2018,a total of 15 patients(13 males and 2 females)with acromial fracture accompanied with acromioclavicular joint dislocation were analyzed retrospectively.Their ages ranged from 18 to 60 years old,and the average age was(34.67±15.53)years.There were 8 cases of traffic injuries,2 cases of fall injuries,3 cases of high falls,and 2 cases of sports injuries.According to the classification of acromial fractures,there were 5 cases of Ogawa type I and 10 cases of Ogawa typeⅡ,and according to the classification of acromioclavicular dislocation,7 cases were Tossy typeⅡ,and 8 cases were TossyⅢ.All acromial fractures were treated with open reduction and hollow screw fixation,and all acromioclavicular joint dislocations were treated with open reduction and clavicular hook plate fixation.One year after the operation,the function of affected shoulders was evaluated according to the range of motion and Constant-Murely scores.Results All patients were followed up for at least one year,with an average follow-up time of(21.60±9.83)months.After operation,the incisions of all the cases were healed by first intention.No complications such as wound infection,poor fracture healing,loss of fracture and dislocation reduction,subacromial impingement,plate and screw loosening occurred.One year after operation,the range of shoulder motions were 90°-145°(114.00±19.29)°of abduction,100°-180°(136.67±27.10)°of up lifting,30°-60°(42.00±10.66)°of posterior extension,and 30°-45°(38.00±6.76)°of external rotation.The Constant-Murely scores were 70-96 points with an average of(85.73±7.26)points.There were 5 cases of excellent cases,7 good cases and 3 moderate cases,and the excellent and good rate was 80%.Conclusions The treatment of acromial fracture and acromioclavicular joint dislocation with clavicular hook plate combined with hollow screw fixation is safe,simple and effective,and the functional recovery is satisfactory.