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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。

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。

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。

锁骨钩钢板治疗重度肩锁关节脱位15例

锁骨钩钢板结合锚钉治疗肩锁关节脱位22例

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。

锁骨钩钢板的临床应用及并发症分析

目的 总结以锁骨钩钢板内固定治疗Neer Ⅱ型锁骨远端骨折和Tossy Ⅲ型肩锁关节脱位的临床应用效果及并发症。 方法 2005 年8 月－ 2010 年2 月，以锁骨钩钢板内固定治疗Neer Ⅱ型锁骨远端骨折20 例和TossyⅢ型肩锁关节脱位28 例，对临床应用效果及术后并发症进行回顾性分析。其中男30 例，女18 例；年龄20 ～ 64 岁，平均33.5 岁。交通事故伤36 例，坠落伤12 例。受伤至手术时间为2 ～ 10 d，平均4.5 d。 结果 术后所有患者切口均Ⅰ期愈合。48 例均获随访，随访时间6 ～ 24 个月，平均13.6 个月。术后发生脱钩2 例、断钩1 例、锁骨应力性骨折1 例、异位骨化1 例、锁骨上皮神经损伤1 例、肩部出现异响不适3 例，均经再手术或对症处理治愈或好转。按洛杉矶加利福尼亚大学（UCLA）肩关节等级评分评定疗效，获优15 例，良27 例，可6 例，优良率87.5%。38 例于术后9 ～ 24 个月取出内固定物，未出现再骨折或肩锁关节再脱位情况。 结论 以锁骨钩钢板内固定治疗Neer Ⅱ型锁骨远端骨折和Tossy Ⅲ型肩锁关节脱位疗效良好，但需注意处理其并发症。

Study on development and biomechanics test of plastic rod-hook plate

ObjectiveTo develop a new type of internal fixation device which can be used to treat the minor avulsion fracture of the medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process, and investigate the reliability and effectiveness of the device through biomechanical test.MethodsEighty human’s bone specimens with complete medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process were selected and measured the anatomic indexes (the height, width, and thickness of medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process). The CT three-dimensional reconstruction data of 200 healthy adults which including medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process was also selected and measured the anatomic indexes by Mimics software. The plastic rod-hook plate was designed according to the measured results and prepared. Forty fresh porcine lower limb specimens were randomly divided into groups A and B (20 in each group), and 8 adult lower limb specimens including 4 left and 4 right were also randomly divided into groups A and B (4 in each group). All specimens were prepared for avulsion fracture of medial malleolus. Then, the fractures were fixed with plastic rod-hook plate in group A and wire anchor in group B. The load and axial torsion test of ankle joint were carried out by universal biomechanical testing machine.ResultsAccording to the anatomical characteristics, a plastic rod-hook plate was designed successfully. The biomechanical test results between animal and human specimens were consistent. There was a linear relationship between load and displacement in the ankle distal load test. The displacement when loaded to the maximum load was significantly lower in group A than in group B (P<0.05). The torsion angle and torque were significantly higher in group A than in group B when the internal fixation failed in the axial torsion test of the ankle joint (P<0.05), and the torsion angle was significantly smaller in group A than in group B when the torque was 1 N·m (P<0.05), and the maximum torque was also significantly higher in group A than in group B (P<0.05). However, there was no significant difference in torsion angle between the two groups in the maximum torque (P>0.05).ConclusionThe biomechanical properties of plastic rod-hook plate is obviously better than wire anchor, and the fixation of avulsion fracture with plastic rod-hook plate is easy to operate, which is expected to be used in the clinical treatment of minor avulsion fractures such as medial malleolus, lateral malleolus, base of the fifth metatarsal, and ulna styloid process.

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.

锁骨钩钢板治疗胸锁关节前脱位八例

目的 总结锁骨钩钢板治疗胸锁关节前脱位的疗效。 方法 2003 年1 月－ 2008 年10 月，采用锁骨钩钢板治疗8 例交通事故伤所致胸锁关节前脱位。男7 例，女1 例；年龄30 ～ 54 岁。左侧2 例，右侧6 例。合并血气胸1 例，下肢骨折1 例，轻度脑外伤1 例。其中1 例脱位后曾行T 型钢板固定，术后15 d 内固定物松动，改为锁骨钩钢板固定；余7 例均为首次手术，受伤至手术时间为3 ～ 5 d。 结果 术后切口均Ⅰ期愈合，无神经、血管损伤及血气胸等并发症发生。8 例均获随访，随访时间6 ～ 15 个月，平均12.3 个月。随访期间X 线片示无内固定失败和再脱位发生。术后6 个月肩关节功能根据Rockwood 等的评分标准评分为12 ～ 14 分，平均13.6 分；其中优7 例，良1 例，优良率100%。 结论 利用锁骨钩钢板治疗胸锁关节前脱位是一种安全、有效的方法。