中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (22): 4057-4061.doi: 10.3969/j.issn.1673-8225.2012.22.016

• 骨科植入物 orthopedic implant • 上一篇    下一篇

钩钢板治疗Rockwood Ⅲ型肩锁关节脱位后内固定物的去留★

张  炜，信维伟，韩晓峰，朱颖华   

  1. 上海交通大学医学院附属仁济医院骨科，上海市   200127
  • 收稿日期:2011-10-13 修回日期:2011-11-30 出版日期:2012-05-27 发布日期:2012-05-27
  • 通讯作者: 朱颖华，博士，副主任医师，上海交通大学医学院附属仁济医院骨科，上海市 200127
  • 作者简介:张炜★，男，1983年生，上海市人，汉族，2008年上海交通大学医学院临床医学毕业，硕士，医师，主要从事创伤骨科临床及相关研究。texaszhang2003@Yahoo.com.cn

Necessity of hook plate removal in surgical treatment of Rockwood type Ⅲ acromioclavicular dislocation 

Zhang Wei, Xin Wei-wei, Han Xiao-feng, Zhu Ying-hua   

  1. Department of Orthopedics, Affiliated Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai  200127, China
  • Received:2011-10-13 Revised:2011-11-30 Online:2012-05-27 Published:2012-05-27
  • Contact: Zhu Ying-hua, Doctor, Associate chief physician, Department of Orthopedics, Affiliated Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • About author:Zhang Wei★, Master, Physician, Department of Orthopedics, Affiliated Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China texaszhang2003@Yahoo.com.cn

PDF

305

被引次数

12

摘要：

背景：肩锁关节脱位内固定后是否须将钩钢板适时取出，在临床实践中仍有一定的争议。
目的：通过对Rockwood Ⅲ型肩锁关节脱位术后随访肩关节功能评分和影像学测量，探讨是否应当早期适时取出钩钢板。
方法：随访急性创伤性肩锁关节脱位(Rockwood Ⅲ型)以钩钢板手术治疗的患者共74例，按内固定后是否早期取出钩钢板分为取出组和保留组。
结果与结论：比较取出组内固定取出前和保留组半年，各项指标差异均无显著性意义。取出组内固定取出后Constant评分、日常活动评分、活动范围评分和OSS评分均高于内固定取出前(P均< 0.05)；疼痛和力量评分前后差异无显著性意义。两组内固定后1年比较，取出组在Constant评分、日常活动、活动范围和OSS评分均高于保留组(P均< 0.05)；疼痛、力量、喙锁间距和肩锁宽度比较，差异均无显著性意义。所有病例均未发生术后感染，再骨折和钢板断裂等并发症。亦未发现在患者体内引起明显的全身和局部反应。结果提示，肩锁关节脱位内固定术后早期适时取出钩钢板，辅以功能锻炼，可以提高Constant和OSS评分，在不影响肩锁关节结构重建的情况下，能更好地恢复肩关节的功能，此外还能减少各种并发症的发生。
 

关键词: 钩钢板, 肩锁关节脱位, Constant评分, OSS评分, 喙锁间距, 肩锁宽度

Abstract:

BACKGROUND: It is still controversial in clinical practice whether the hook plate should be removed or not timely after surgical treatment on acromioclavicular joint dislocation.
OBJECTIVE:To evaluate the necessity of early hook plate removal after surgery on Rockwood type Ⅲ acromioclavicular joint dislocation by follow-up with shoulder functional assessment and radiographic measurement.
METHODS: Seventy-four cases of acute traumatic acromioclavicular dislocation (Rockwood type Ⅲ) treated with hook plate internal fixation were followed up. All patients were divided into either removal group with plate removal and retaining group without removal.
RESULTS AND CONCLUSION: There were no significant differences of each indicator in the removal group before internal fixation and retaining group after half one year. Constant score, activities of daily living, range of motion and Oxford Shoulder Score (OSS) scores after removal were significantly higher than those of before removal (P < 0.05), However, pain and strength scores showed no significant difference. At 1 year after internal fixation, compared with the retaining group, constant score, activities of daily living, range of motion and OSS score were increased in the removal group (P < 0.05), and pain, strength, coracoclavicular distance and acromioclavicular width were not significantly changed. There were no postoperative infection and complications of re-fracture and plate breakage in all the cases, and significant systemic and local reactions were also not found. It is indicated that shoulder function rehabilitation can be reached by improving Constant and OSS score after exercise if hook plate can be early removed after internal fixation in the treatment of acromioclavicular dislocation. Meanwhile, the anatomy of acromioclavicular joint remains the same and further complications can be reduced.

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