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Self-made dentation hook plate associated with hot-air balloon technique on treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus

ObjectiveTo observe effectivness and safeness of self-made dentation hook plate associated with hot-air balloon technique in treating Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus.MethodsBetween January 2016 and December 2018, 15 patients with Mutch Ⅰ or Ⅱ type greater tuberosity fractures were treated with self-made dentation hook plate associated with hot-air balloon technique. There were 9 males and 6 females with an average age of 45.1 years (range, 29-62 years). The injury causes included falling injury in 9 patients and traffic accident injury in 6 patients. According to Mutch classification, 4 cases were MutchⅠ type and 11 cases were Mutch Ⅱ type. There were 7 cases with anterior dislocation of shoulder. The time from injury to operation was 2-10 days (mean, 4.5 days).ResultsAll 15 patients were followed up 8-16 months, with an average of 13.5 months. There was no infection of incision, loss of reduction of fracture block, delayed union or nonunion. The average time of fracture union was 6.5 months (range, 4-8 months). One patient had axillary paralysis at 1 day after operation, and was treated with nutritional nerve therapy, the symptoms disappeared after 2.5 months. Three patients had slight subacromial impingement. After fracture healing, the hook plate was taken out in advance, and the pain and abnormal noise disappeared during shoulder abduction. At last follow-up, Costant-Murley score used to evaluate shoulder joint function was 88-100, with an average of 96.8; 8 cases were excellent, 7 cases were good, and the excellent and good rate was 100%. The internal fixator was removed after 8-16 months after the secondary operation with no re-fracture occurred.ConclusionThe self-made dentation hook plate associated with hot-air balloon technique is a safe and reliable method for the treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fracture of humerus.

Clavicular Hook Plate and Modified Weaver-Dunn Procedure for Tossy Ⅲ Type Old Acromioclavicular Joint Dislocation

目的　探讨锁骨钩钢板并改良Weaver-Dunn技术治疗Tossy Ⅲ型陈旧性肩锁关节脱位的疗效。 方法　2007年１月－2011年１月，对12例Tossy Ⅲ型陈旧性肩锁关节脱位采用锁骨钩钢板并改良Weaver-Dunn技术治疗。其中3例为肩锁关节脱位手术后再次发生脱位，2例合并锁骨远端骨折采用保守治疗无效，余7例单纯性陈旧性肩锁关节脱位未经任何检查治疗。 结果　术后患者切口均Ⅰ期愈合，无神经血管损伤、无切口感染等并发症。12例均获随访，随访时间12～30个月。X线片示锁骨复位情况良好，去除内固定后未见肩锁关节脱位复发。肩锁关节功能好，局部畸形消失，无肩周肌肉萎缩及肩周炎出现，锁骨位置良好。手术疗效评价：获优10例，良2例，优良率100%。 结论　锁骨钩钢板并改良Weaver-Dunn技术治疗Tossy Ⅲ型陈旧性肩锁关节脱位，复位固定满意，韧带重建易成功，肩关节功能恢复好，是一种治疗陈旧性肩锁关节脱位较理想的方法。

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。

REPAIR OF ACROMIOCLAVICULAR DISLOCATION WITH CLAVICULAR HOOK PLATE INTERNAL FIXATION AND CORACOACROMIAL LIGAMENT TRANSPOSITION

To explore the operative method and the cl inical outcomes of repairing acromioclavicular dislocation by clavicular hook plate internal fixation and coracoacromial l igament transposition. Methods From August 2004 to December 2007, 12 cases of acromioclavicular dislocation were repaired with the internal fixation of clavicular hook plate and the transposition of coracoacromial l igament. There were 9 males and 3 females aged 22-56 years old (average 32 yearsold). Causes of injury: 6 cases from fall ing injury, 4 cases from crush injury and 2 cases from traffic accident. There were 5 cases of the left acromioclavicular dislocation, and 7 cases of the right. According to acromioclavicular dislocation classification set by WANG Yicong, 8 cases were graded as type III, 3 cases as type IV, and 1 case as type V. The time from injury to operation was 3-28 days (average 6 days). The injured arm was hung after operation, and the function training was started 3-5 days after operation. Results All wounds healed by first intention, and the X-ray films showed complete reposition of acromioclavicular joints was achieved in all cases 1 week after operation. Over the follow-up period of 12-30 months, no plate and screw loosening, hook break and acromion fracture occurred. At 2 months after operation, 2 patients had sl ight pain when moving the shoulder, and the symptom disappeared when removing the plate. No re-dislocation was observed in all cases after removing the plate at 6-10 months after operation. The function of shoulder joint was assessed by Karlsson evaluation standard 1 year after operation, 11 cases were graded as excellent and 1 case was good. Conclusion For the repair of acromioclavicular dislocation, the method of combining clavicular hook plate internal fixation with coracoacromial l igament transposition has the advantages of minor wound, easy operation, l ittle influence on the function of shoulder joints, and rel iable restoration of the stabil ity of shoulder joint.

自制齿状钩钢板结合热气球技术治疗合并侧方碎骨块的尺骨鹰嘴撕脱骨折

目的总结自制齿状钩钢板结合热气球技术治疗合并侧方碎骨块的尺骨鹰嘴撕脱骨折的临床疗效及注意事项。方法回顾分析 2016 年 1 月—2018 年 4 月采用自制齿状钩钢板结合热气球技术固定治疗的 9 例合并侧方碎骨块的尺骨鹰嘴撕脱骨折患者临床资料。其中男 5 例，女 4 例；年龄 30～74 岁，平均 53.7 岁。致伤原因：交通事故伤 1 例，高处坠落伤 1 例，机器损伤 1 例，摔伤 6 例。均为横形骨折，合并侧方 1～3 块大小不一碎骨块。骨折按 Colton 分型均为Ⅰ型。受伤至手术时间 2～11 d，平均 5.9 d。结果术后切口均Ⅰ期愈合。9 例均获随访，随访时间 6～16 个月，平均 11.2 个月。2 例消瘦患者术后鹰嘴部皮下出现内固定激惹，1 例出现轻度异位骨化。患者术后均无内固定物松动、断裂，无继发骨折移位、再骨折，无血管神经损伤等并发症发生。术后 3 个月 X 线片示骨折均达临床愈合。术后 1 个月肘关节屈伸活动度为 10～105°，3 个月时为 5～125°，6 个月时为 5～135°，末次随访时为 3～136°。按 Broberg-Morrey 标准评定肘关节功能，获优 7 例、良 2 例，优良率 100%。结论自制齿状钩钢板结合热气球技术治疗合并侧方碎骨块的尺骨鹰嘴撕脱骨折经济简便、固定可靠，允许术后早期功能锻炼，疗效确切。

EFFECTIVENESS COMPARISON OF CORACOCLAVICULAR LIGAMENT RECONSTRUCTION BETWEEN BY AUTOLOGOUS AND ALLOGENEIC TENDON GRAFTS COMBINED WITH HOOK PLATE FIXATION FOR TREATING ACROMIOCLAVICULAR JOINT DISLOCATION

ObjectiveTo compare the effectiveness of coracoclavicular ligament reconstruction between by using autologous plantaris tendon graft combined with hook plate fixation and allogeneic tendon graft combined with hook plate fixation for treating acromiocavicular joint dislocation. MethodsThirty-three patients with acromioclavicular joint dislocation who accorded with the inclusion criteria between January 2013 and June 2014 were assigned into 2 groups. The patients were treated with autologous plantaris tendon graft combined with hook plate fixation in group A (n=17), and with allogeneic tendon graft combined with hook plate fixation in group B (n=16). Thirteen-one patients was followed up more than 12 months (15 in group A and 16 in group B). There was no significant difference in gender, age, cause of injury, sides, time between injury and surgery, and type of dislocation (P>0.05). The assessments included operation time, hospitalization time, hospitalization expenses, shoulder range of motion, gap of acromioclavicular, Constant-Murley scores, and visual analogue scale (VAS) for pain. ResultsThe operation time of group A was significantly longer than that of group B, and the hospitalization expense was significantly lower than that of group B (P<0.05). There was no significant difference in hospitalization time (t=1.046, P=0.316). The incisions healed by first intention, and hook plate was removed after 3 months. The mean follow-up time was 21.3 months (range, 19-34 months) in group A and was 23.7 months (range, 18-37 months) in group B. X-ray examination showed no osteolysis. There was no significant difference in gap of acromiocavicular between 2 groups at preoperation, 1 week after operation, and last follow-up (P>0.05). No redislocation of acromioclavicular joint and rejection reaction occurred during follow-up. At last follow-up, there was no significant difference in shoulder range of motion, Constant-Murley score, and VAS score between 2 groups (P>0.05). ConclusionCoracoclavicular ligament reconstruction by autologous plantaris tendon or allogeneic tendon graft combined with hook plate fixation for the treatment of acromioclavicular joint dislocation can achieve good effectiveness. The appropriate treatment should be chosen according to the patient's economic situation.

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。

锁骨钩钢板结合锚钉治疗肩锁关节脱位22例

Clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of unstable distal clavicle fractures

ObjectiveTo evaluate the effectiveness of a clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of Neer types Ⅱ and Ⅴ distal clavicle fractures.MethodsBetween January 2010 and June 2016, 16 patients with Neer types Ⅱ and Ⅴ distal clavicle fractures were treated with clavicle hook plates and coracoclavicular ligament augmentation by suture anchor. There were 12 males and 4 females with an average age of 45.6 years (range, 14-81 years). The injury mechanism included falling in 10 cases, traffic accident injury in 2 cases, falling from height in 2 cases, and heavy object injury in 2 cases. The Neer classification of clavicle fractures included 2 cases of type Ⅱa, 13 cases of type Ⅱb, and 1 case of type Ⅴ. The injury severity score (ISS) was 6-29, with an average of 11.2. The time from injury to operation was 1-18 days, with an average of 6.4 days. The operation time, intraoperative blood loss, hospitalization stay, fracture healing, and postoperative complications were recorded; the disability of arm, shoulder, and hand (DASH) score, the shoulder joint Constant score, and the Oxford shoulder score (OSS) were used to evaluate the shoulder joint at last follow-up.ResultsAll operations were successfully completed. The operation time was 50-100 minutes, with an average of 75.6 minutes; intraoperative blood loss was 30-100 mL, with an average of 52.8 mL; hospitalization stay was 4-47 days, with an average of 13.7 days. All patients were followed up 1.2-7.5 years, with an average of 3.5 years. All clavicle fractures healed, and the healing time was 9.4-13.6 weeks, with an average of 11.9 weeks. No fracture nonunion, fracture displacement, failure of internal fixation, or incision infection, etc. occurred. Fifteen patients took out the hook plate after fracture healing and functional recovery, and 1 case refused to remove the hook plate from the second operation because of no obvious discomfort. At last follow-up, the DASH score was 0-13, with an average of 2.2; the shoulder joint Constant score was 90-100, with an average of 96.8; the OSS score was 12-14, with an average of 12.3.ConclusionClavicular hook plate with coracoclavicular ligament augmentation by suture anchor can help achieve good effectiveness with less postoperative complication in the treatment of Neer types Ⅱ and Ⅴ distal clavicular fractures.

锁骨钩钢板固定结合喙锁韧带重建治疗陈旧性肩锁关节脱位

目的 总结锁骨钩钢板固定结合喙锁韧带重建治疗陈旧性肩锁关节脱位的临床疗效。 方法 2003 年6 月－ 2008 年12 月，采用锁骨钩钢板固定结合喙锁韧带重建治疗17 例陈旧性肩锁关节脱位。男11 例，女6 例；年龄16 ～ 53 岁，平均39 岁。均为直接暴力致伤。左侧7 例，右侧10 例。Rockwood 分型：Ⅲ型14 例，Ⅳ型2 例，Ⅴ型1 例。受伤至手术时间为14 ～ 55 d，平均23 d。 结果 术后切口均Ⅰ期愈合。肩锁关节脱位均纠正，无神经、血管损伤等并发症发生。术后患者均获随访，随访时间6 ～ 15 个月，平均12 个月。术后3 ～ 6 个月取出锁骨钩钢板，无再脱位发生。术后6 个月按Karlsson 疗效评价标准：优12 例，良4 例，差1 例，优良率94.1%。 结论 锁骨钩钢板固定结合喙锁韧带重建具有操作简便、创伤小、固定可靠、可早期功能锻炼等优点，是治疗陈旧性肩锁关节脱位的一种有效方法。