肩锁关节脱位钩钢板固定的并发症与对策

Complications of hook plate fixation for acromioclavicular dislocation and corresponding countermeasures

[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.