锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位

目的探讨锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位的临床疗效。 方法回顾性分析本院骨科自2008年1月至2018年12月收治的15例肩峰骨折合并肩锁关节脱位患者的临床资料，其中男13例、女2例；患者年龄范围18 ~ 60岁，平均年龄（34.67±15.53）岁；致伤原因：交通伤8例，摔伤2例，坠落伤3例，运动伤2例。肩峰骨折分型，OgawaⅠ型5例，OgawaⅡ型10例；肩锁关节脱位分型，TossyⅡ型7例，TossyⅢ型8例。治疗方案均为肩峰骨折采用切开复位空心钉内固定治疗，肩锁关节脱位采用切开复位锁骨钩钢板内固定治疗。术后1年根据患者患侧肩关节活动范围及肩关节Constant-Murely评分对患者进行功能评价。 结果所有患者均获得至少1年以上随访，平均随访时间（21.60±9.83）个月，术后患者切口均一期愈合，未发生伤口感染、骨折愈合不良、骨折脱位复位丢失、肩峰下撞击、钢板螺钉松动等情况。术后1年肩关节活动范围：外展90° ~ 145°，平均（114.00±19.29）°；上举100°～180°，平均（136.67±27.10）°；后伸30° ~ 60°，平均（42.00±10.66）°；外旋30° ~ 45°，平均（38.00±6.76）°。术后1年Constant-Murely评分70 ~ 96分，平均（85.73±7.26）分，优5例，良7例，可3例，优良率80％。 结论锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位操作安全、简单、疗效确切，术后患者功能恢复满意，值得在临床中应用。     

锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位

目的探讨锁骨钩钢板在锁骨远端骨折和肩锁关节脱位中的治疗效果。方法对56例锁骨远端骨折和肩锁关节脱位患者行切开复位锁骨钩钢板内固定术。结果伤口感染2例,经换药愈合。56例均获随访,时间4～16个月。内固定松动及脱出3例,锁骨中段骨折1例,锁骨钩钢板锁骨钩不在肩峰下1例,均经石膏固定愈合;X线片显示锁骨骨折全部愈合,肩锁关节无再脱位发生。按照Karlsson评价标准：优40例,良11例,差5例,优良率91.1%。结论锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位创伤小、固定牢固、能早期活动肩关节,是治疗锁骨远端骨折和肩锁关节脱位有效的方法。     

锁骨钩钢板内固定治疗肩锁关节脱位和锁骨远端骨折

目的观察锁骨钩钢板内固定治疗肩锁关节脱位和锁骨远端骨折的手术效果。方法切开复位后按左右侧选择不同锁骨钩钢板内固定及韧带修补技术治疗锁骨远端骨折和肩锁关节脱位32例。结果32例均获随访,时间4~38个月。根据Karlsson疗效标准,优21例,良11例。结论切开复位锁骨钩钢板内固定是治疗肩锁关节脱位和锁骨远端骨折一种较好的手术方法。     

锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位

目的观察应用锁骨钩钢板对NeerⅡ型的锁骨远端骨折和TossyⅢ型的肩锁关节脱位进行切开复位内固定的治疗效果。方法从2003年6月至2007年12月，我院外科共收治17例锁骨远端骨折（NeerⅡ型）和24例肩锁关节脱位（TossyⅢ型）的病人。41例病人均行手术治疗锁骨钩钢板内固定，术后早期行肩袖等肌肉的收缩练习，3周左右可进行肩关节功能活动。术后随访3～27个月。结果采用Lazzcano标准评定：优36例，良5例。术后6周均完全恢复日常生活和工作能力，无一例患者出现伤口感染，未发生锁骨下神经、血管损伤，内固定无松动及脱出，无骨折不愈合或畸形愈合等现象，X线片显示锁骨骨折全部愈合，肩锁关节无再脱位发生。随访X线片显示未见肩锁关节半脱位或钢板断裂和松动。结论锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位具有固定牢靠、不损伤关节面、关节功能恢复快等优点，是一种可靠的手术方法。     

锁骨远端解剖型锁定钢板治疗锁骨远端骨折的疗效分析

目的探讨锁骨远端解剖型锁定钢板在锁骨远端骨折治疗中的应用。方法对26例CraigⅡ类Ⅱ、Ⅴ型锁骨外1/3骨折进行切开复位锁骨远端解剖型锁定钢板固定。结果本组24例获得随访6~24个月,肩关节功能评分为88～97分,平均92分,优16例,良6例,可2例,优良率为91.7%。结论采用锁骨远端解剖型锁定钢板治疗CraigⅡ类Ⅱ、Ⅴ型锁骨远端骨折,术后肩关节疼痛及肩关节活动受限发生率低,术后并发症少,有利于肢体早期功能恢复。     

成人锁骨中段移位骨折的手术治疗

目的 探讨切开复位内固定治疗成人锁骨中段移位骨折的疗效.方法 2006年1月至2010年12月手术治疗118例成人单纯锁骨中段移位骨折,男93例,女25例;年龄18～85岁,平均47.6岁.骨折按Robinson分类:2A2型4侧,2B1型61侧,2B2型55侧,均为闭合性骨折.均行切开复位,用重建接骨板固定,7例于骨折处植骨.按美国加州大学洛杉矶分校(UCLA)肩关节评分标准(Ellman法)评定术后功能.结果 107例患者术后获6～43个月(平均16.0个月)随访.伤口均一期愈合,无感染发生.骨折均获骨性愈合,平均愈合时间为10周.3例出现内固定失效.按UCLA肩关节评分标准(Ellman法)评定术后功能:优56例,良47例,可4例,优良率为96.3％.结论 对于成人锁骨中段移位骨折,一期采用切开复位、接骨板内固定疗效较好.     

锁骨钩钢板在锁骨远端骨折脱位中的应用

目的评价锁骨钩钢板治疗NeerⅡ型锁骨远端骨折和TossyⅢ型肩锁关节脱位的临床疗效。方法对2004--2009年收治的25例新鲜NeerⅡ型锁骨远端骨折和31例新鲜TossyⅢ型肩锁关节脱位患者进行切开复位锁骨钩钢板内固定手术治疗,术中均未修复断裂的喙锁韧带,根据X线片评估骨折愈合或肩锁关节复位情况。采用ConstantandMurley肩关节评分系统评定患肩术前、术后（末次随访时）的功能,并以患者的健侧肩作为对照,进行比较分析评价。结果本组随访9个月-2年,术后X线片证实25例骨折患者全部达到骨性愈合,31例肩锁关节脱位患者未出现再脱位。未发现钢板断裂、螺钉松动及骨折移位等情况。患肩术前ConstantandMurley评分（24．40±2．17）分与术后（91．90土3．84）分比较,差异有非常显著性意义（P〈0．01）,患肩术后（91．90±3．84）分与健肩（94．90±2．85）分比较,无显著性差异（P=0．63）。结论采用锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位具有创伤小、固定确实可靠、无需刻意修复喙锁韧带、可早期行肩关节功能锻炼等优点,是临床较为理想的固定方式,具有较满意的临床疗效。     

锁定钢板治疗锁骨远端Neer Ⅱb型骨折的疗效分析

[目的]探讨锁骨远端锁定加压钢板内固定方法治疗NeerⅡb型锁骨远端骨折的临床疗效。[方法]回顾性分析2012年3月~2013年8月采用锁骨远端前外侧lateral compression plate(LCP)治疗15例NeerⅡb型锁骨远端骨折的资料,男9例,女6例;年龄22~64岁,平均42.1岁;左侧5例,右侧10例。采用锁骨上方横行切口,复位骨折后使用锁定钢板内固定,对于钢板固定后肩锁关节仍不稳定的,采用喙突置入带线锚钉修复喙锁韧带。术后定期摄X线片,采用Constant、SF-36评分系统分别对术后肩关节功能及全身功能进行评定。[结果]15例锁骨远端骨折患者均获随访,随访时间14~26个月,平均20.5个月。X线片显示锁骨骨折均在4~6个月内愈合,平均骨折愈合时间4.5个月。Constant肩关节功能评分,优11例,良4例,优良率100%。与健侧肩关节的功能评分接近。SF-36评分为85.5~100分,平均94.6分。末次随访时,无1例发生钢板断裂、钢板周围骨折和肩袖损伤等并发症。[结论]切开复位锁骨远端锁定加压钢板内固定方法治疗NeerⅡb型锁骨远端骨折能取得良好的临床疗效,具有肩关节功能恢复好、并发症少等优点,是治疗锁骨远端骨折较好的内固定方法。     

保护锁骨上神经对锁骨中远端骨折内固定术的临床疗效分析

[目的]探讨锁骨中远端粉碎性骨折切开复位内固定术中保护锁骨上神经对治疗骨折的临床疗效。[方法]回顾性分析2011年7~2013年7月应用锁定加压钢板治疗的87例锁骨中远端粉碎性骨折患者的临床资料,其中前期38例术中均切断锁骨上神经(切断组),后期49例术中均保护性游离锁骨上神经(游离组);观察分析两组的手术时间、术中出血量、术后骨折愈合时间、术后Constant-Murly肩功能评分及术后手术区皮肤感觉障碍面积等指标。[结果]87例锁骨中远端粉碎性骨折患者均获得随访,术后随访时间12~24个月,平均20.5个月,两组平均骨折愈合时间均为3个月,无明显差异。术后7个月采用Constant-Murly评分对肩关节功能进行评价,其中切断组优29例,良6例,优良率92%;游离组优39例,良9例,优良率98%。术后3、7个月分别评估两组手术区感觉障碍面积;与切断组相比,术后3、7个月游离组手术区感觉障碍面积均明显降低(P0.01)。[结论]锁骨中远端粉碎性骨折进行手术内固定时,术中游离保护锁骨上神经可避免该神经损伤,术后皮肤感觉功能障碍明显降低,且有利于患侧肩功能康复,是一种值得推广的操作方式。     

尼斯结联合解剖锁定钢板治疗成人锁骨中段粉碎骨折疗效分析

目的探讨尼斯结联合解剖锁定钢板治疗成人粉碎锁骨中段骨折的临床疗效。 方法回顾性分析我科于2014年1月至2017年2月采用尼斯结联合解剖锁定钢板治疗28例成人锁骨中段粉碎骨折临床资料,末次随访采用Constant-Murley评分及Lazzcano评定标准进行肩关节功能评价。 结果28例患者术后获6~16个月随访,平均（10.27±3.22）个月,手术时间55~90 min,平均（63.33±21.27）min,术中出血量40~100 ml,平均（62.67±19.07）ml。手术切口均一期愈合,无伤口感染、内固定相关的松动或断裂并发症发生,2例消瘦患者出现钢板刺激皮肤不适而行内固定取出。末次随访时肩关节Constant-Murley评分为80~100分,平均（90.00±5.98）分,Lazzcano评定标准进行疗效评价,其中优20例,良6例,中2例,优良率为92.86%。 结论尼斯结联合解剖锁定钢板治疗粉碎锁骨中段骨折可达到良好解剖复位、内固定稳定、愈合率高、并发症少,是治疗锁骨中段粉碎骨折的一种新选择。     

锁定加压钢板治疗锁骨远端Neer IIB 型骨折

 目的 探讨采用锁骨远端前外侧锁定加压钢板(locking compression plate, LCP)治疗锁骨远端Neer IIB 型骨折的疗效。方法 回顾性分析2009 年1 月至2010 年10 月采用锁骨远端前外侧LCP治疗11 例Neer IIB 型锁骨远端骨折的资料, 男9 例, 女2 例;年龄23~43 岁, 平均37.2 岁;左侧5例, 右侧6例;损伤至手术时间为24~72 h, 平均48 h。骨折复位后将LCP 置于锁骨远端上方, 首先采用锁定螺钉固定锁骨远端, 可根据骨折的长度选择3~6枚2.5 mm 的锁定螺钉, 然后用3.5 mm锁定螺钉固定骨折近端, 无需修复喙锁韧带。采用美国肩肘外科医师学会(American Shoulder and Elbow Surgeons, ASES)评分评价术后肩关节功能。结果 11 例患者均获得随访, 随访时间为9~12 个月, 平均10.3 个月。X 线片示锁骨骨折均愈合, 其中10 例在术后6 个月内骨折愈合, 1 例在术后9 个月骨折愈合。11 例患者ASES 评分为84~91 分, 平均89.1 分, 与健侧肩关节的功能评分相近。末次随访时, 无一例发生钢板断裂、钢板周围骨折和肩袖损伤等并发症。结论 采用锁骨远端前外侧LCP治疗Neer IIB 型锁骨远端骨 折可以稳定锁骨远端, 避免骨折不愈合和经肩关节固定锁骨远端的并发症。     

Treatment of distal clavicle fracture with distal radius volar locking compression plate

Objective: To observe the early clinical outcomes of the internal fixation with distal radius volar locking compression plate (LCP) in treatment of distal clavicle fracture.Methods: Six patients with unilateral distal clavicle fractures, identified as type Ⅱ according to Neer classification system, including 4 males and 2 females, were treated with open reduction and internal fixation using a distal radius volar LCP. Bone union was evaluated by routine X-ray radiography, and shoulder joint function were assessed by Constant score system.Results: All fractures achieved bone union at 6 to 8 weeks postoperatively, and Constant scores ranged from 95 to 100 at the postoperative 10 to 12 weeks.Conclusion: Fixation of distal clavicle fracture with distal radius volar LCP demonstrates excellent effects of bone union with rarely early complications, thus providing a new technique to treat distal clavicle fracture.     

Transacromial Knowles pin in the treatment of Neer type 2 distal clavicle fracturesA prospective evaluation of 32 cases

BACKGROUND: The high rate of non-union makes surgical intervention necessary for a distal clavicle fracture. This report presents the outcome of a simple surgical method using a transacrominal Knowles pin for this unstable fracture. METHODS: In this study, 32 patients with Neer type 2 distal clavicle fractures were treated using a single transacromial Knowles pin without repair of the torn ligament. All 32 patients were studied prospectively and followed up for a mean of 80 months (range, 12-132 months). The clinical outcome was evaluated with the UCLA score, and the fracture union was judged roentgenographically. RESULTS: All the patients showed excellent results with solid union. The mean union time was 6.8 weeks (range, 4-12 weeks). No major complication was noted, and only one asymptomatic acromioclavicular arthrosis developed. CONCLUSIONS: Single transacrominal Knowles pin fixation offers a simple and safe method for treating patients with displaced Neer type 2 distal clavicle fractures.     

关节镜下双Endobutton钢板结合经皮克氏针髓内固定治疗NeerII型锁骨远端骨折疗效分析

目的 探讨关节镜下双Endobutton钢板结合经皮克氏针髓内固定治疗NeerII型锁骨远端骨折的临床疗效。 方法 回顾性分析我院骨科2020年9月至2022年1月间13例NeerII型锁骨远端骨折经关节镜下双Endobutton钢板结合经皮克氏针髓内固定手术的临床结果。通过收集术前及末次随访时患者的Constant评分,VAS疼痛评分,肩关节前屈、外展活动度评价患者术后肩关节功能恢复情况,通过术后X片随访了解骨折愈合的时间。 结果 本组患者共13例,男性8例,女性5例,平均年龄37.6岁（21-53岁）,按照Neer分型,11例为NeerIIA型,2例是NeerIIB型。13例患者均获得随访,平均随访时间6.5月（4-9月）。术前患者的Constant评分、VAS疼痛评分、肩关节前屈活动度、外展活动度分别是40.30±5.75分、4.69±1.25分、70.77±6.41度、64.23±7.60度。术后末次随访Constant评分、VAS疼痛评分、肩关节前屈活动度、外展活动度分别是 96.00±5.96分、0.23±0.60分、169.23±11.52度、163.77±12.40度,较术前均有明显改善,差异有统计学意义（P=0.000）。所有患者骨折均愈合,平均愈合时间4.6月（3-8月）。 结论 关节镜下双Endobutton钢板结合经皮克氏针髓内固定治疗NeerII型锁骨远端骨折疗效满意,同时具有微创、不干扰肩峰下间隙、不需要二次手术取出内固定等优点,可以作为治疗NeerII锁骨远端骨折的手术选择方案。     

Use of the AO hook-plate for treatment of unstable fractures of the distal clavicle

Introduction We used a new internal fixative implant, the AO clavicle hook-plate, for treatment of unstable fractures of the distal clavicle. This study describes the operative procedure and the clinical results obtained, as well as discussion of the advantages and problems encountered. Patients and methods Fifteen consecutive patients with unstable fractures of the distal clavicle (Neer type II) were treated using AO clavicle hook-plates. The average age of patients was 47 years and there were 13 males and 2 females. The mean follow-up period was 15.5 months. Plain radiographs of clavicles were used to assess bony union. Functional recovery of the shoulder joint was assessed using the Constant–Murley scoring system. Results All fractures eventually achieved solid bony union within 4 months after surgery. Thirteen patients (87%) showed hook migration into the acromion. Clinical results were excellent with a mean Constant–Murley score of 89 points at final follow-up. Conclusion AO clavicle hook-plates are useful fixative implants for unstable fractures of the distal clavicle. Static fixation was achieved and physiotherapy can be started immediately after surgery. Early removal of the implant is recommended however because hooks inserted under the acromion migrated into the bone in most cases.     

钩钢板和解剖锁定板治疗锁骨远端NeerⅡ型骨折的疗效比较

目的比较解剖锁定板和钩钢板治疗锁骨远端NearⅡ型骨折的疗效。方法对32例锁骨远端NeerⅡ型骨折患者分别采用解剖锁定板固定(18例)和钩钢板固定(14例)。结果患者均获得随访,时间9~20个月。患者骨折均愈合,无伤口感染、内固定失效等并发症发生。钩钢板组出现2例肩关节疼痛、外展受限,3例肩峰下骨侵蚀,于术后6~8个月取出内固定物,肩关节疼痛逐渐缓解,功能恢复良好。术后3、6个月解剖锁定板组肩关节功能优于钩钢板组(P0.01),内固定物取出后3个月,两组肩关节功能比较差异无统计学意义(P0.05)。结论解剖锁定板和钩钢板都是治疗锁骨远端NeerⅡ型骨折的有效方法,应根据不同的骨折选择合适的内固定物。     

解剖锁定钢板联合锚钉治疗NeerⅡb型锁骨远端粉碎骨折

目的探讨解剖锁定钢板联合锚钉治疗NeerⅡb型锁骨远端粉碎骨折的疗效。方法采用解剖锁定钢板联合锚钉治疗18例NeerⅡb型锁骨远端粉碎骨折患者。末次随访采用Constant-Murley评分标准进行肩关节功能评定。结果患者均获得随访,时间10~27个月。1例术后发生浅表切口感染,经换药及口服抗生素后愈合;其余17例均无切口感染、骨折延迟愈合、内固定松动、断裂及继发骨折等并发症发生。骨折全部愈合,时间10~20周。末次随访时,喙锁间距患侧与健侧比较差异无统计学意义(P>0.05);Constant-Murley评分为81~98分,其中优14例,良4例。结论解剖锁定钢板联合锚钉治疗NeerⅡb型锁骨远端粉碎骨折,可获得接近解剖的喙锁间距及良好的肩关节功能,且骨折愈合快、并发症少。     

Special status of lateral clavicular fracture]

Fractures of the lateral clavicle have different biomechanical conditions compared with fractures of the medial and central third; they therefore demand different therapy. Some 237 patients with fractures of the clavicle were followed, of which 75 (33%) were located in the lateral third of the clavicle. At the 5-year follow-up after exclusively conservative treatment, good results were found for Neer types I and III and 3 J?ger/Breitner type IIb fractures, while 4 out of 13 J?ger/Breitner type II a fractures ended in pseudarthroses (31%). Conservative treatment is recommended for Neer types I and III, as well as for the more stable J?ger/Breitner type II b and old II a fractures. Therefore, a new bandage is presented. It prevents the posterior and upward dislocation of the proximal fragment by vertical compression and rotation of the distal fragment by fixation of the arm. Open reduction and internal fixation by preferably extraarticular implants is recommended for unstable and dislocated J?ger/Breitner type II a fractures. For fractures of the lateral clavicle, good results can be achieved when the instability is recognized and adequately treated.     

术中超声精准引导下闭合复位弹性髓内钉固定治疗锁骨骨折的疗效

目的:探讨超声精准引导在锁骨骨折闭合复位弹性髓内钉（TEN）固定手术中的应用效果。方法:回顾性分析2017年1月至2019年3月山东省文登整骨医院急诊创伤科术中在超声精准引导下进行骨折闭合复位TEN固定治疗的40例新鲜锁骨骨折患者资料。男25例,女15例;年龄25~68岁,平均52.1岁;左侧27例,右侧13例。观测术...     

Treatment of unstable distal clavicle fractures using two suture anchors and suture tension bands

Objective

The study presents a surgical technique using two suture anchors combined with two non-absorbable suture tension bands and the clinical and radiological results obtained in patients with acute distal clavicle fractures associated with coracoclavicular ligaments disruption.

Materials and methods

Nineteen patients with distal clavicle fractures were included with a mean follow-up of 25 months. All patients had type IIb fractures according to the Neer classification. Coracoclavicular ligaments were reconstructed using two suture anchors to maintain distal clavicle in an anatomical position, and supplementary interfragmentary fixation was performed using two non-absorbable suture tension bands in figure-of-eight configurations. Functional outcomes were assessed at final follow-up visits using the Constant score.

Results

The numbers of lateral fragments averaged 1.4. Seventeen patients maintained the same vertical coracoclavicular distance between both shoulders. However, in two patients, the coracoclavicular distance of the injured shoulder increased by 50% compared with that of the contralateral shoulder. Fracture union was obtained in 18 patients at a mean 4.8 months postoperatively. One patient had symptomatic nonunion until 9 months postoperatively, and subsequently, distal clavicle resection was performed. Two patients showed delayed union and achieved fracture union at 9 and 10 months postoperatively, respectively. Clavicular erosion was found in two patients. The lateral fragment of one patient united in an upward angulated position caused by over-tightening of the medial clavicle. The average Constant score improved to 94.

Conclusion

Coracoclavicular reconstruction using two suture anchors and supplementary interfragmentary fixation using two non-absorbable suture tension bands for acute distal clavicle fracture are reliable techniques for restoring stability in patients with acute distal clavicle fracture.