Prevention and countermeasures of specific postoperative complications of clavicle hook plate

doi:10.3969/j.issn.2095-4344.2014.48.017

Abstract

Abstract:

BACKGROUND: Clavicle hook plate has been widely applied in the treatment of acromioclavicular joint dislocation and the distal fracture of clavicle and achieved satisfactory effects. The increasing application is associated with the emergency of some complications such as shoulder pain, subacromial impingement, subacromial osteolysis, hook-release, and stress fracture.
OBJECTIVE: To analyze the complications and causes after the operations for the acromioclavicular joint dislocation and the distal fracture of clavicle with clavicle hook plate, and to summarize prevention and treatment measures.
METHODS: From March 2006 to May 2014, 112 patients with acromioclavicular joint dislocation (64 cases) and the distal fracture of clavicle (48 cases) were cured by clavicle hook plate. Among them, 16 patients with distal fracture of clavicle of Neer type I, 32 patients of Neer type II; and 64 patients with acromioclavicular joint dislocation of Tossy type III. Four patients with superior shoulder suspensory complex double damage. The clinical results of hook plate internal fixation and the complications were retrospectively analyzed.
RESULTS AND CONCLUSION: Finally 103 patients were involved in the follow-up analysis and other cases were excluded due to loss of follow-ups. 99 patients exhibited synostosis and no re-dislocation of acromioclavicular joint occurred. The incidence rate of postoperative complications was 30.1%. According to
Karlsson criteria, 79 patients got an excellent result, and 16 good. The excellent and good rate was 92.2%. Clavicle hook plate internal fixation is reasonable and effective for the treatment of the acromioclavicular joint dislocation and the distal clavicle fracture. Treatment should be based on the characteristics of individual, and wide concerns are needed to prevent complications.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: internal fixators, calvicle, fracture, acromioclavicular joint, postoperative complications, follow-up studies

CLC Number:

R318

Zou Wei, Xiao Jie, Long Hao, Wu Chen, Zhou Chang-jun. Prevention and countermeasures of specific postoperative complications of clavicle hook plate[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(48): 7804-7809.

Figures/Tables 2

2.1 参与者数量分析纳入112例患者，103例获得随访并进入结果分析，其余病例因患者原因短期内失访，不予纳入结果分析。 2.2 治疗结果内固定后1个月首次复查，以后每3个月复查1次肩关节正位X射线片。随访时间6-18个月，内固定后6-15个月取出钢板，平均11.4个月，锁骨远端骨折以骨折线消失为基本标准，肩锁关节脱位平均8个月取出钢板，本组中有99例显示骨折端愈合良好，肩锁关节对位良好，无脱位。 3例(2.9%)肩锁关节脱位患者内固定后显示肩锁关节前下方半脱位，1例(1.0%)浮肩损伤患者内固定后3 d出现锁骨钩钢板钩滑脱征象，内固定基本失效，3例合并喙突基底部骨折悬吊复合体损伤患者，同时行喙突螺钉固定，愈合良好，7例(6.8%)内固定后出现严重的关节功能锻炼时疼痛，不能上举，外展，至术后半年内固定取出后得到一定缓解。内固定取出后遗留轻中度肩关节功能障碍16例(15.5%)。内固定后出现螺钉松动征象3例(2.9%)，共31例出现内固定后并发症，并发症发生率30.1%。本组未出现钢板断裂、再骨折、脱位复发等情况。 2.3 功能评价结果内固定后1周行肩关节功能评价，采用 Karlsson 标准，失访患者除外，优79例，良16例，差8例，优良率92.2%，疗效较满意。 2.4 典型病例病例1：男性患者，34岁，诊断“右侧肩锁关节脱位Ⅲ型”，伤后第3天行切开复位锁骨钩钢板内固定，所采用钢板尺寸不佳，导致肩锁关节过度向下复位(图1A)，与对侧正常肩X射线(图1B)比较可见仍然处于半脱位状态，术后钩端过大应力导致后期肩峰下骨质切割及术后肩关节功能受限，6个月取出内固定行功能锻炼，肩关节功能恢复评分良。病例2：男性患者，41岁，诊断“右侧肩锁关节脱位并喙突基底部骨折悬吊复合体损伤”(图2A)，伤后第4天行切开复位锁骨钩钢板内固定、喙突螺钉内固定，使肩关节上部悬吊复合体得到恢复和稳定(图2B)，内固定后随访12个月各项功能恢复满意。病例3：男性患者，64岁，诊断“左侧锁骨远端骨折”(图3)，伤后第5天行切开复位锁骨钩钢板内固定，钢板安装位置欠佳，内固定后远端螺钉松动、退出迹象，内固定后肩关节外展受限明显，术后12个月骨折愈合取出内固定，随访至18个月肩关节功能评分差。"

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