Tossy Ⅲ度肩锁关节脱位术后常见并发症

目的：回顾性分析TossyⅢ度肩锁关节脱位术后常见并发症及其防治措施。方法：48例TossyⅢ度肩锁关节脱位患者分别以克氏针张力带内固定（A组）14例、拉力螺钉或钢丝内固定（B组）11例、锁骨钧钢板内固定（C组）23例，分析3类术后发生的并发症，总结产生原因及防治措施。结果：48例患者均获随访，随访时间2个月～3年，平均18个月。A组优8例，良4例，差2例；B组优7例，良3例，差1例；C组优21例，良1例，差1例。术后优秀率A、C组间差异有显著性意义，P〈0．05；A组术后疼痛4例，肩周炎3例，肩锁关节炎3例，内固定失效4例，再次脱位2例；B组术后疼痛3例，肩用炎2例，肩锁关节炎1例，内固定失效3例，再次脱位1例；C组术后疼痛2例，肩周炎2例，肩锁关节炎1例，内固定失效2例，再次脱位l例。术后并发症组间差异无统计学意义（P〉0．05）。结论：选择合适的内固定方式和合理重建喙锁、喙肩韧带是治疗肩锁关节脱位的基本要求。术中对肩锁关节间隙的彻底清理，韧带的确切重建．以及术中切实可靠的坚强固定才是减少并发症的有效手段。

Postoperative complications of acromioclavicular joint dislocation of Tossy Ⅲ

Objective ：To analyze retrospectively the postoperative complications of aeromioclavicular joint dislocation （Tossy Ⅲ） and explore the preventative methods for the complications. Methods ： Forty-eight cases of acromioclavicular joint dislocation（Tossy Ⅲ ） were reviewed, 14 cases treated with open reduction and Kirschner wire combined with steel wire fixation （group A）, 11 cases treated with open reduction and lag screw or steel wires fixation （group B） ,23 cases treated with open re- duction and AO clavicular hook plate fixation （group C ）. The acromioclavicular ligament, articular capsule, eoracoclavicular ligament and coracoaeromial ligament were repaired in all patients. The reasons of postoperative complications were analyzed. Results：Forty-eight patients got average follow-up of 18 months. In group A, 8 patients obtained excellent results ,4 good and 2 poor ;in group B,7,3 and 1, respectively ;in group C,21,1 and 1, respectively. The excellence rate showed statistical difference between group A and C （P〈0.05）. In group A,4 cases with postoperative pain,3 cases with periarthritis of shoulder,3 cases with arthritides of acromioclavicular joint, 4 cases with internal fixation failure and 2 cases with recurrence of joint dislocation ; in group B, 3,2,1,3 and 1, respectively ; in group C, 2,2,1,2 and 1, respectively. There was no significant difference in postoperative complications in three groups （P〉0.05）. Conclusion：Selection of the suitable internal fixation and reconstruction of coracoelavieular and coracoacromia ligaments is the basic operation. Acromioclavicular space debridement,ligamentous re- construction,rigid internal fixation are effective methods to reduce postoperative complications for the treatment of acromio- clavicular joint dislocation.