锁骨钩钢板治疗锁骨远端骨折术后并发症原因分析

Analysis of the Causes of Postoperative Complications of Clavicular Hook Plate in the Treatment of Distal Clavicular Fracture

目的:探讨分析锁骨钩钢板治疗锁骨远端骨折术后并发症发生的原因,并提出对策。方法:通过研究2018年1月至2020年12月在梧州市中医医院应用锁骨钩钢板治疗的38例Neer分型Ⅱ型锁骨远端骨折患者,分析其术后并发症的原因。结果:术后随访1~18个月,平均12.7个月。钢板留存时间平均12.5个月。所有骨折均骨性愈合,平均愈合时间12.8周。术后肩关节疼痛23例,3个月后缓解9例,拆除内固定后缓解12例,遗留慢性疼痛2例;钢板周围骨折1例,经重置钢板后也得到骨性愈合;肩峰下骨溶解8例;锁骨钩脱钩1例;肩峰下撞击15例。结论:应用锁骨钩钢板治疗锁骨远端骨折操作简便、疗效确切,但术后并发症发生率高,大多数并发症发生的原因与钢板设计自身的特点有关。可通过研发更加适用于国人解剖特点的钩钢板,或术中适当的二次塑形,提高手术者的手术技巧及术后的管理来有效降低术后并发症的发生。

Objective:To explore and analyze the causes of postoperative complications of clavicular hook plate in the treatment of distal clavicular fracture,put forward countermeasures.Methods:38 patients with Neer type II distal clavicular fracture treated with clavicular hook plate in Wuzhou Traditional Chinese Medicine Hospital from January 2018 to December 2020 were studied,and the causes of postoperative complications were analyzed.Results:The patients were followed up for 1 to 18 months,with an average of 12.7 months.The average retention time of steel plates is 12.5 months.All fractures healed with with an average healing time of 12.8 weeks.There were 23 cases of postoperative shoulder pain,9 cases were relieved after 3 months,12 cases were relieved after the removal of internal fixation,and 2 cases were left with chronic pain;one case of peri plate fracture also got bone healing after plate replacement;subacromial osteolysis in 8 cases;clavicular hook was unhooked in 1 case;subacromial impact in 15 cases.Conclusion:Clavicular hook plate is simple and effective in the treatment of distal clavicular fractures,but the incidence of postoperative complications is high.Most of the causes of complications are related to the characteristics of the plate design.The incidence of postoperative complications can be effectively reduced by developing hook plate more suitable for the anatomical characteristics of Chinese people,or appropriate secondary shaping during operation,so as to improve the operator's surgical skills and postoperative management.