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。
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.
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.
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。
Objective To compare the effectiveness of clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation and distal clavicle fractures. Methods A clinical data of 90 patients, who underwent clavicular hook plate fixation between January 2014 and June 2023, was retrospectively analyzed. There were 40 patients with distal clavicle fractures (fracture group) and 50 with acromioclavicular joint dislocations (dislocation group). There was no significant difference in the baseline data of gender, age, cause of injury, side of injury, time from injury to operation, and constituent ratio of osteoporosis patients between the two groups (P>0.05). The time to remove the internal fixators and the occurrence of complications were recorded. Before removing the internal fixator and at 3 months after removing, the visual analogue scale (VAS) score was used to evaluate the degree of pain, and the mobility of the shoulder joint in forward flexion, elevation, and abduction was measured. Before removing the internal fixators, the Constant-Murley score and the University of California, Los Angeles (UCLA) score were used to evaluate the function of the shoulder joint. X-ray films of the shoulder joint were taken during follow-up to observe the occurrence of subacromial osteolysis, acromioclavicular joint osteoarthritis, and distal clavicle bone atrophy. Subgroup comparison was conducted between patients with and without subacromial osteolysis in the two groups. Results All incisions healed by first intention in both groups. All patients were followed up 1-9 years, with a median of 5 years; the difference in follow-up time between the two groups was not significant (P>0.05). During follow-up, subacromial osteolysis occurred in 74 cases, including 41 cases of typeⅠand 33 cases of type Ⅱ, distal clavicle bone atrophy in 15 cases, and acromioclavicular joint osteoarthritis in 8 cases. There were significant differences in the removal time of internal fixators, the incidence of bone atrophy, and the incidence of osteoarthritis between the two groups (P<0.05). There was no significant difference in the incidence of subacromial osteolysis (P>0.05). Before removing the internal fixators, there was no significant difference in VAS score, UCLA score, and Constant-Murley score between the two groups (P>0.05), while there were significant differences in shoulder joint range of motion in all directions (P<0.05). After removing the internal fixators, only the difference in elevation was significant (P<0.05). Within the group comparison, the VAS score and mobility of shoulder joint in abduction and elevation after removing the internal fixators were significantly superior to those before removing (P<0.05). In the fracture and dislocation groups, there was only a significant difference in plate length between the subgroup with and without subacromial osteolysis (P<0.05), while there was no significant difference in the above other indicators (P>0.05). Conclusion Clavicular hook plate is a good choice for treating acromioclavicular dislocation or distal clavicle fractures, but the incidence of subacromial osteolysis is higher, and the degree of bone resorption is more severe in fracture patients. After removal of the internal fixator, the shoulder functions significantly improve. It is recommended to remove the internal fixator as soon as possible within the allowable range of the condition.