新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折脱位的疗效观察

目的:探讨新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折脱位的临床疗效。方法 :自2011年6月至2013年12月,应用胸锁钩钢板对32例成年胸锁关节骨折脱位患者进行手术治疗。其中男24例,女8例;年龄25~76岁,平均42岁;胸锁关节前脱位12例,胸锁关节后脱位5例,锁骨内侧端骨折10例,骨折合并脱位5例。胸锁关节前骨折脱位采用标准胸锁钩钢板,后脱位则在钢板钩的远端,即胸骨柄前方加用螺母和垫片,预防术后再脱位。根据Rockwood评分法评定疗效。结果 :患者手术过程中无并发症发生。术后复查X线片及CT显示胸锁关节解剖位置正常,内固定位置良好。32例均获得随访,时间6~24个月,平均10个月。术后3~6个月骨折达Ⅰ期愈合,胸锁关节无再脱位,锁骨内侧端解剖结构均恢复,功能满意,其中9例患者胸锁关节周围存在肿胀,但无疼痛等症状。Rockwood评分结果12.78±1.43;疗效优24例,良8例。结论:使用该新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折,内植物固定确实可靠,安全性高,操作简便,为治疗此类创伤提供了一种可靠的方法。

A new type sternoclavicular hook plate for unstable sternoclavicular joint dislocation and fracture

Objective: To evaluate the therapeutic effect of a new type sternoclavicular hook plate fixation in treating unstable sternoclavicular joint dislocation and fracture.Methods: From June 2011 to December 2013,32 patients with sternoclavicular joint dislocation and fracture were treated with a new type sternoclavicular hook plate fixation,including 24 males and 8 females with an average age of 42 years ranging from 25 to 76 years;12 patients were anterior dislocation,5 pations were posterior dislocation,10 patients were internal extremity of clavicle fracture and 5 patients were sternoclavicular joint dislocation combined with fracture. The anterior fracture dislocation of the sternoclavicular joint adopted standard sternoclavicular joint hook plate,and the posterior dislocation was at the distal end of the hook of the steel plate,that is,the front part of the handle of the breast was added with a nut and a gasket to prevent the re-dislocation after operation. The results were evaluated according to Rockwood score.Results: No complication happened in all patients. X-ray and CT showed that the dislocation and fracture of the sternoclavicular joint was well reduced and the plate was on right position. All patients were followed up for 6 to 24 months with an average of 10 months. At 6 to 3 months after operation,the fracture was healing without re-dislocation of the sternoclavicular joint,the medial end of the clavicle anatomical structure were restored,functional satisfaction,in which 9 patients with the swelling around sternoclavicular joint,but no pain and other symptoms. The total Rockwood score was 12.78±1.43; the results were excellent in 24 cases,good in 8 cases.Conclusion: The use of the new type of locking hook plate for the treatment of unstable fracture of the sternoclavicular joint,internal fixation is reliable,high security,easy to operate,to provide a reliable method for the treatment of such trauma.