摘要
[目的]探讨肩锁关节脱位采用钩钢板治疗术后并发症及处理对策。[方法]回顾性分析2011年1月—2021年1月采用锁骨钩钢板固定急性肩锁关节脱位的105例患者的临床资料,评估期临床结果和并发症。[结果] 105例均顺利完成手术,术中无血管、神经损伤等严重并发症。随访过程中,105例患者中,97例患肩活动明显受限,活动时疼痛,于术后10~20个月,平均(12.3±5.3)个月取出钩钢板。取钩钢板术中,12例同时行关节镜下检查,发现肩峰下滑膜炎2例,肩峰下撞击2例,肩峰下表面磨损8例。与术后3个月相比,末次随访时患侧VAS评分、Constant-Murley评分、前屈上举ROM和外展上举ROM均显著改善(P<0.05)。相应时间点,患侧VAS评分、Constant-Murley评分、前屈上举ROM和外展上举ROM均显著不及健侧(P<0.05)。术后影像检查发现,105例患者中,98例出现不良影像表现,占84.8%。发生率由高至低依次为:肩峰骨质磨损86/105 (81.9%),肩峰撞击15/105 (14.3%),肩锁关节炎6/105 (5.7%),肩锁关节向下半脱位6/105 (5.7%),钢板脱位或者肩锁关节前方半脱位4/105 (3.8%),钢板折断固定松动、锁骨近端骨折3/105 (2.9%)。各类不良影像表现的发生率差异无统计学意义(P=0.242)。[结论]肩锁关节脱位钩钢板内固定并发症发生率高,单纯喙锁韧带断裂引起的肩锁关节脱位应尽量避免使用钩钢板。
[Objective] To investigate the postoperative complications and their management strategies of hook plate fixation of acromioclavicular dislocation. [Methods] A retrospective study was performed on 105 patients who received clavicular hook plate fixation for acute acromioclavicular dislocation from January 2011 to January 2021. The clinical results and complications were evaluated. [Results]All 105 cases were successfully operated on without serious complications such as vascular and nerve injury. During the follow-up, 97 patients of them had significant limitation of shoulder movement and pain during movement, and had the hook plate removed from 10 to 20months with a mean of(12.3±5.3) months. In the hook plate removal, 12 cases underwent arthroscopic examination simutaneously, which revealed subacromial synovitis in 2 cases, subacromial impingement in 2 cases, and subacromial surface abrasion in 8 cases. Compared with3 months after surgery, the VAS score, Constant-Murley score, forward flexion-lifting range of motion(ROM), and abduction-lifting ROM on the affected side were significantly improved at the last follow-up(P<0.05). However, the involved side proved significantly inferior to the health side in terms of VAS and Constant-Murley scores, as well as ROMs at the corresponding time points(P<0.05). Radiographically, of the 105 patients 98 patients had adverse imaging findings accounting for 84.8%. The incidence was ranked from high to low as follows: acromioclavicular bone wear 86/105(81.9%), acromioclavicular impingement 15/105(14.3%), acromioclavicular arthritis 6/105(5.7%), acromioclavicular subluxation downward 6/105(5.7%), plate dislocation or anterior acromioclavicular subluxation 4/105(3.8%).There was no significant difference in the incidence of all types of adverse imaging findings(P=0.242). [Conclusion] The hook plate internal fixation for acromioclavicular dislocation has considerably high complication occurrence, should avoid being used for acromioclavicular dislocation caused by coracoclavicular ligament rupture as far as possible.
作者
刘镇煌
黄长明
范华强
章亚青
LIU Zhenhuang;HUANG Chang-ming;FAN Hua-qiang;ZHANG Ya-qing(Department of Orthopaedics,Chenggong Hospital,Xiamen University,Xiamen 361003,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2023年第2期111-116,共6页
Orthopedic Journal of China
关键词
肩锁关节脱位
钩钢板
并发症
对策
acromioclavicular dislocation
hook plate
complications
countermeasures