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EyresⅢA型喙突骨折的手术治疗

目的 总结Eyres ⅢA型喙突骨折手术治疗方法及效果。 方法 2010年8月－2014年8月，采用锁骨钩钢板固定肩关节联合喙突骨折解剖复位后2枚空心钉固定治疗4例Eyres ⅢA型喙突骨折患者。男3例，女1例；年龄36～41岁，平均39岁。致伤原因：交通事故伤3例，机器伤1例。伤后至入院时间2～12 h，平均6 h。 结果 术后患者切口均Ⅰ期愈合，无感染、皮肤坏死等术后早期并发症发生。4例均获随访12个月。术后4个月取出锁骨钩钢板，保留空心钉。术后8个月CT示骨折完全愈合。随访期间无肩关节再脱位，内固定物松动、断裂，继发骨折等发生。术后12个月根据Neer肩关节功能评分标准评分为83～87分，平均85分。 结论 对于Eyres ⅢA型喙突骨折，采用锁骨钩钢板固定肩关节联合喙突骨折解剖复位后2枚空心钉固定可行且疗效满意。

Application of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique for acute acromioclavicular joint dislocation

Objective To investigate the effectiveness of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique in the treatment of acute acromioclavicular joint dislocation. Methods A clinical data of 28 patients with acute acromioclavicular joint dislocation who met the selection criteria and admitted between June 2018 and December 2021 was retrospectively analyzed. There were 18 males and 10 females, with an average age of 47.7 years (range, 22-72 years). The causes of injury included falling (13 cases) and traffic accidents (15 cases). The acromioclavicular joint dislocation was rated as Rockwood type Ⅲ in 7 cases, type Ⅳ in 16 cases, and type Ⅴ in 5 cases. The time from injury to operation was 4-13 days, with an average of 9.5 days. The acromioclavicular joint dislocation was reconstructed with TightRope system and high-strength wire by Locking-Loop methods during operation. The operation time and complications were recorded. Visual analogue scale (VAS) score, Constant-Murley score, and active range of motion of shoulder (forward flexion and upward lift, abduction and upward lift, and external rotation) were recorded before operation and at 12 months after operation to evaluate the functional recovery of shoulder. The loss of acromioclavicular joint reduction was assessed by comparing the coracoclavicular distance (CCD) based on the anteroposterior X-ray films at 3 days and 12 months after operation. Results The operation time was 58-100 minutes (median, 85 minutes). All incisions healed by first intention. All patients were followed up 12 months. During follow-up, 2 patients developed shoulder adhesion, which recovered after rehabilitation exercise. At 12 months after operation, the VAS score was significantly lower, the Constant-Murley score was significantly higher, and the range of motion of the shoulder joint (forward flexion and upward lift, abduction and upward lift, and external rotation) significantly increased when compared with preoperative ones (P<0.05). X-ray films showed that the CCD was 8.4 (7.3, 9.4) and 9.2 (8.1, 10.1) mm at 3 days and 12 months after operation, respectively, with a significant difference (Z=−4.665, P<0.001). During follow-up, there was no complication such as infection, titanium plate entrapment, fracture, internal fixation failure, or redislocation. ConclusionThe treatment of acute acromioclavicular joint dislocation with TightRope system combined with Locking-Loop biplane anatomical reconstruction has the advantages of small incision, joint reduction under direct vision, high fixation strength, and low incidence of postoperative complications, which can effectively relieve the pain of patients’ shoulder joint and facilitate the recovery of shoulder joint function.

钢丝联合重建钢板治疗分离性肩锁关节脱位的近期疗效观察

【摘要】　目的　总结采用钢丝联合重建钢板治疗分离性肩锁关节脱位的临床近期疗效。　方法　2008年2月-2010年11月，采用钢丝联合重建钢板治疗分离性肩锁关节脱位4例。男2例，女2例；年龄24~45岁，平均年龄33.5岁。肩锁关节均呈分离性脱位，分离距离4.0~6.5 cm，平均5.2 cm。受伤至手术时间2~4 d。治疗后参照Karlsson评价标准，根据疼痛程度、上肢肌力、肩部活动度及X线片检查中肩锁关节间隙进行疗效评定。　结果　3例获随诊，随访时间2~12个月，平均5.6个月。X线片示肩锁关节位置正常，无钢板螺钉断裂、松动。术后2个月，按Karlsson标准评价疗效，获优1例，良2例。　结论　钢丝联合重建钢板治疗分离性肩锁关节脱位固定牢固，符合生物力学要求，可早期进行功能锻炼，获得良好的临床效果。

EFFECTIVENESS COMPARISON OF TRIPLE ENDOBUTTONS AND CLAVICULAR HOOK PLATE FOR TREATMENT OF FRESH ACROMIOCLAVICULAR JOINT DISLOCATION

ObjectiveTo compare the effectiveness of triple Endobuttons and clavicular hook plate fixation in the treatment of fresh acromioclavicular joint dislocation (Rockwood type III-V). MethodsBetween February 2008 and October 2010, 40 patients with fresh acromioclavicular joint dislocation (Rockwood type III-V) were treated with triple Endobuttons in 18 cases (trial group) and with clavicular hook plate in 22 cases (control group). There was no significant difference in gender, age, disease duration, joint dislocation classification, preoperative visual analogue scale (VAS) score and Constant-Murley score between 2 groups (P gt; 0.05). ResultsAfter operation, wound healed by first intention with no early complication of infection or neurovascular injury. The patients were followed up 12-20 months (mean, 15.8 months) in trial group and 13-24 months (mean, 17.2 months) in control group. Significant differences were found in the VAS score and Constant-Murley score at the last follow-up between 2 groups (P lt; 0.05). X-ray films showed no loosening of internal fixators or hook displacement occurred. No re-dislocation was observed. ConclusionTriple Endobuttons has less shoulder pain and better shoulder motion than clavicular hook plate, so it is an effective method of treating Rockwood type III-V fresh acromioclavicular joint dislocation.

TREATMENT OF FRESH TOSSY TYPE III ACROMIOCLAVICULAR JOINT DISLOCATIONS AND NEER TYPE II DISTAL CLAVICLE FRACTURES WITH CLAVICULAR HOOK PLATE

Objective To investigate the cl inical efficacy, compl ications and necessity of removing internal fixation in treatment of fresh Tossy type III acromioclavicular joint dislocations and Neer type II distal clavicle fractures with clavicularhook plate. Methods From June 2005 to June 2008, 24 patients with fresh Tossy type III acromioclavicular joint dislocations and 20 patients with fresh Neer type II distal clavicle fractures were treated. There were 32 males and 12 females with an agerange of 18-66 years (38.5 years on average), involving 18 left shoulders and 26 right shoulders. The injury was caused bytraffic accident in 31 cases and by fall ing in 13 cases. The mean time from injury to operation was 4 days (range, 2-8 days). All patients were treated by reduction with clavicular hook plate fixation. The coracoclavicular l igaments were not sutured. The shoulder functions were evaluated according to University of Cal ifornia-Los Angeles (UCLA) score system and analysed before and after removing internal fixation. Results Wound infection occurred in 2 cases 1 week after operation and healed after symptomatic managment, the other incisions healed by first intention. One case accepted hook plate fixation again because of loosening hooking-up 1 week after operation. One case accepted hook plate removal and Kirschner wire fixation because of severe shoulder’s pain on the postoperative third day. Thirty-eight patients were followed up for 8-32 months (18 months on average), there was no plate breakage. Clavicle fractures got bony union after 3-6 months (4.2 months on average). At last followup (before plate removal), according to UCLA shoulder function score system, the results were excellent in 11 cases, good in 22 cases, and fair in 5 cases; the excellent and good rate was 86.8%. Because of shoulder’s pain, plates were removed in 20 patients 3-16 months (10 months on average) after operation. The cases were followed up 3-8 months (5 months on average) after removing plate. No dislocation and fracture occurred again. There was statistically significant difference (P lt; 0.01) in the functional scores of shoulder between before (30.55 ± 4.00) and after removing internal fixation (33.85 ± 1.95). Conclusion Clavicular hook plate fixation is an effective treatment for fresh Tossy type III acromioclavicular joint dislocations and Neer type II distal claviclefractures. Normative operating, correct plate moulding, functional rehabil itation after operation are key factors in preventingcompl ications and reaching good cl inical efficacy. For the patients with postoperative symptoms, the plate should be removed to improve the shoulder’s function.

钩钢板治疗锁骨外侧端骨折伴肩锁关节脱位

锁骨钩钢板治疗Ⅲ度肩锁关节脱位

双Endobutton双环套锁内固定术治疗Tossy Ⅲ型肩锁关节脱位及Neer ⅡB型锁骨远端骨折

目的总结双Endobutton双环套锁内固定术治疗TossyⅢ型肩锁关节脱位和NeerⅡB型锁骨远端骨折的疗效。 方法2010年4月－2013年4月采用双Endobutton双环套锁内固定术治疗17例Tossy Ⅲ型肩锁关节脱位和7例Neer ⅡB型锁骨远端骨折患者。男16例，女8例；年龄18～47岁，平均34岁。受伤至手术时间1～7 d，平均3.5 d。 结果术后患者切口均Ⅰ期愈合，无感染、臂丛神经及血管损伤等并发症发生。21例获随访，其中14例脱位患者随访时间12～20个月，7例骨折患者为12～24个月。锁骨远端骨折均获骨性愈合，愈合时间4～8个月，平均6个月。随访期间肩锁关节脱位无复发。术后12个月，Constant-Murley评分：脱位患者为（89.3±3.2）分，骨折患者为（87.2±2.6）分；按Karlsson标准评定：脱位患者获A级14例，B级3例；骨折患者获A级5例，B级2例。 结论双Endobutton双环套锁内固定术治疗Tossy Ⅲ型肩锁关节脱位和Neer ⅡB型锁骨远端骨折创伤小，手术操作简便，近期疗效满意。

带骨块喙肩韧带内移加锁骨钩钢板固定治疗 Tossy Ⅲ型肩锁关节脱位

目的  总结采用带肩峰骨块喙肩韧带内移加锁骨钩钢板固定治疗 Tossy Ⅲ型肩锁关节脱位的近期疗效。  方法  2003年6月－2008年3月，采用带肩峰骨块喙肩韧带内移重建喙锁韧带、肩锁关节锁骨钩钢板固定治疗35例Tossy Ⅲ型肩锁关节脱位。男24例，女11例；年龄17～58岁，平均32岁。车祸伤21例，摔伤10例，高处坠落伤4例。左侧 13 例，右侧 22 例。新鲜脱位 26 例，陈旧性脱位 9 例。受伤至手术时间 2 ～ 30 d，平均 9 d。  结果  术后切口Ⅰ期愈合 34 例，延期愈合 1 例。患者均获随访，随访时间 10 ～ 36 个月，平均 18 个月。术后钢板无松动、断裂，去除内固定后无肩锁关节再脱位、肩周肌肉萎缩及肩周炎发生。术后 10 个月肩关节功能参照 Lazzcano 标准评定：获优 31 例，良 4 例，优良率100%。   结论  采用带肩峰骨块喙肩韧带内移重建喙锁韧带、联合锁骨钩钢板固定治疗Tossy Ⅲ型肩锁关节脱位，手术操作简便，对肩部生理功能影响小，韧带重建可靠，内固定牢固，近期疗效满意。

Long-term Clinical and Radiological Outcomes of Kirschner Tension Band Fixation versus Clavicular Hook Plate for RockwoodⅢ Acromioclavicular Joint Dislocation

目的　比较克氏针张力带与锁骨钩钢板治疗RockwoodⅢ型肩锁关节脱位的临床疗效。 方法　1999年1月－2007年3月，收治肩锁关节脱位患者29例，分别采用克氏针张力带联合喙锁韧带重建（克氏针组10例）和锁骨钩钢板（钢板组19例）治疗。其中男18例，女11例；年龄19～50岁，平均38.2岁。患者均为新鲜RockwoodⅢ型肩锁关节脱位，受伤至手术时间1～16 d，平均3 d。两组患者性别、年龄、受伤至手术时间等一般资料比较差异无统计学意义（P＞0.05）。进行两组患者术后临床及影像学评估比较。 结果　25例患者（克氏针组10例，钢板组15例）获随访，随访时间2～12年，平均6年。术后克氏针组发生克氏针弯曲5例、断裂1例；钢板组切口浅表感染2例，经换药后治愈，其余患者切口Ⅰ期愈合。两组患者肩锁关节均获得良好功能，组间比较差异无统计学意义（P＞0.05）。影像学方面：与克氏针组相比，在患肢负重位时钢板组喙锁间隙间距增加了23%（P＜0.05），非负重位两组间距差异无统计学意义（P＞0.05）。术后8～12周出现喙锁韧带钙化，钢板组12例、克氏针组2例（P＜0.05）。术后6个月出现肩锁关节骨性关节炎，钢板组2例、克氏针组1例（P＞0.05）。肩关节功能与影像学结果无相关性（r=0.096，P＞0.05）。 结论　克氏针张力带联合喙锁韧带重建和锁骨钩钢板固定治疗RockwoodⅢ型肩锁关节脱位均可获得良好的临床功能。与克氏针张力带相比，锁骨钩钢板固定具有手术操作简便、疗效确切、并发症少、能够早期康复锻炼等优点。