肩锁钩钢板治疗肩锁关节脱位和锁骨骨折

目的：探讨治疗肩锁关节脱位和锁骨骨折的新方法。方法：采用肩锁钩钢板治疗Ⅲ度肩锁关节脱位ll例，锁骨外端骨折7例，锁骨中段骨折4例，20例获得随访，随访时间4—18个月，平均10.2个月。结果：按照Lazzcano标准，疗效优14例，良6例，无其他并发症，骨折全部愈合，肩锁关节无再脱位。结论：肩锁钩钢板治疗肩关节脱位和锁骨骨折具有固定确实，不损伤关节面，可以早期功能锻炼等优点，值得推广。术中仍需注意修复喙锁韧带。     

Wolter肩锁钩钢板治疗肩锁关节脱位

肩锁关节脱位是肩部的常见损伤之一,主要为车祸伤、坠落伤等直接暴力所致。严重的肩锁关节脱位(PostⅢ型以上或RockwoodⅢ型～Ⅵ型)1常需手术治疗,以解决局部畸形和疼痛、功能障碍等问题。尽管术式较多,但术式间差异较大,取得的结果也不尽相同。在2001年12月至2003年2月,本院采用德国Link公司的Wolter肩锁钩钢板治疗肩锁关节脱位,取得了满意的结果。1资料与方法1.1一般资料:本组急性肩锁关节脱位11例,男9例,女2例。年龄29～55岁,平均41岁。其中合并锁骨外侧端骨折3例,肩胛骨体骨折1例。手术时间在伤后3～10天,平均6天。均经左右肩关节X片…     

AO肩锁钩钢板治疗肩锁关节完全脱位临床疗效评价

目的 评价AO肩锁钩钢板治疗肩锁关节完全脱位的临床疗效。方法 本组43例，其中23例采用A0肩锁钩钢板、辅以肩锁韧带与喙锁韧带可吸收缝线修补术；20例采用克氏针内固定术。结果 根据术后X线片和关节功能恢复情况评定疗效，两者的疗效优良率分别为95．6％、65％，疗效差异有统计学显著性意义。结论 应用A0肩锁钩钢板、重建喙锁韧带和肩锁韧带治疗肩锁关节完全脱位疗效可靠。     

应用Woltre钢板治疗肩锁关节周围骨折脱位14例

肩锁关节周围骨折脱位在临床上较多见，治疗的关键是复位和维持复位。我们应用Wolter钢板治疗肩锁关节周围骨折脱位14例，疗效满意。     

弧型钩钢板治疗肩锁关节脱位

肩锁关节脱位是肩部常见损伤 ,治疗方法较多。我们自1995年以来自行设计弧型钢板 ,临床治疗肩锁关节脱位Ａｌｌ ｍａｎ分类法Ⅱ、Ⅲ度急性脱位 2 1例 ,取得满意疗效。1　临床资料　本组 2 1例 ,男性 16例 ,女性 5例 ;平均年龄 32 .3岁 ( 18～5 6) ,左侧 6例 ,右侧 15例。全部为新鲜损伤。伤后距手术时间最短 3ｄ ,最长 12ｄ。均为Ａｌｌｍａｎ分类Ⅱ、Ⅲ度脱位 ,术前Ｘ线片见图 3,术后Ｘ线片见图 4。2　手术方法钢板见图 1,由 2ｍｍ医用不锈钢制成 ,钢板长度有 5 5ｍｍ ,60ｍｍ ,65ｍｍ 3种型号 ,左右 2种规格。固定示意图见图 2。高位臂丛…     

AO钩钢板治疗肩锁关节脱位

目的探讨AO钩钢板治疗肩锁关节脱位的疗效;方法对我院2000年1月至2005年10月间收治的42例Tossy型肩锁关节脱位的患者采用AO钩钢板治疗;结果42例患者均得到随访,随访时间6-24个月,平均11.5个月。按Karlsson标准评定,A级34例,B级8例;结论应用AO钩钢板治疗Tossy型肩锁关节脱位固定可靠,可早期行肩关节功能锻炼,疗效满意。     

AO锁骨钩钢板治疗肩锁关节脱位

目的探讨AO锁骨钩钢板治疗肩锁关节脱位的疗效。方法2001年6月～2004年6月,采用AO锁骨钩钢板治疗11例TossyⅢ型肩锁关节脱位患者。结果11例患者均获6～12个月随访。术后6～12个月(平均8.5个月)拔除内固定。按Lazzcano标准评定,优8例,良3例,优良率为100%。无切口感染、内固定失败等并发症。结论AO锁骨钩钢板是治疗肩锁关节脱位的有效方法之一。     

Wolter钩形钢板治疗肩锁关节脱位

目的：观察应用Wolter钩形钢板对PostⅢ级及部分PostⅡ级肩锁关节脱位进行手术治疗的临床效果。方法：从2001年4月～2003年6月，应用Wolter钩形钢板治疗PostⅢ级肩锁关节脱位13例，PostⅡ级肩锁关节脱位l例。结果：14例均获得随访，平均随访9(7～18)个月。术后3～7d所有患者均能肩关节主动功能锻炼，术后6个月肩关节活动均恢复正常或接近正常。随访无钢板螺钉松动、断裂及肩锁关节脱位复发。术后结果按Karl 1som A、B、C分级：A级12例，B级2例，取得满意的临床疗效。结论：Woler钩形钢板是治疗肩锁关节脱位的一种较好的手术方法。     

Link肩锁钢板治疗肩锁关节脱位和锁骨远端骨折

目的 观察运用Link肩锁钢板对Tossy Ⅲ型的肩锁关节脱位和Nccr Ⅱ型的锁骨远端骨折进行切开复位内固定手术的临床效果。方法 从2000年6月—2002年8月，运用Link肩锁钢板治疗肩锁关节脱位和锁骨远端骨折15例病人。结果 术后2周所有患者均能进行肩关节主动活动，术后6周均恢复日常生活和工作能力。随访病例的X线片未见肩锁关节脱位或钢板断裂和松动的表现。结论　Link肩锁钢板是治疗Tossy Ⅲ型肩锁脱位和Neer Ⅱ型锁骨远端骨折的一种较好的方法。     

Wolter钩钢板治疗肩锁关节脱位

目的探讨Wolter钩钢板治疗肩锁关节脱位的方法和疗效。方法治疗肩锁关节脱位12例，观察疗效。结果本组随访9～28个月，平均17个月，内固定无失败，以Karlsson标准进行肩关节功能评价：优9例，良3例。结论Wolter钩钢板治疗肩锁关节脱位，固定可靠、可早期活动、功能恢复好，值得推广。     

AO/ASIF锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位

目的：观察运用AO/ASIF锁骨钩钢板（Clavicular HookPlate)对TossyⅢ型的肩锁关节脱位和NeerⅡ型的锁骨远端骨折进行切开复位内固定手术的临床效果。方法：从2000年3月-2001年3月，运用AO/ASIF锁骨钩钢板及韧带修补技术，治疗了15例急性锁骨远端骨折（NeerⅡ型）和肩锁关节脱位（TossyⅢ型）的病人。结果：术后1周所有患者均能进行肩关节主动活动，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，随访的X线未见肩锁关节半脱位或钢板断裂和松动的表现。结论：AO/ASIF锁骨钩钢板是治疗TossyⅢ型肩锁关节脱位的NeerⅡ型锁骨远端骨折的一种较好的手术方法。     

Combination of Clavicular Hook Plate with Coracoacromial Ligament Transposition in Treatment of Acromioclavicular Joint Dislocation

ObjectiveTo evaluate the clinical efficacy of Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate (CHP) combined with coracoacromial ligament transposition for Rockwood III‐V dislocation of AC joint, providing an alternative choice for AC joint dislocation treatment.MethodsTwenty‐five patients diagnosed with Rockwood III‐V dislocation of acromioclavicular (AC) joint, including 18 males and seven females, aged 43.5 ± 2.4 years old on average, who had undergone open reduction and AO CHP in combination with coracoacromial (CC) ligament transposition between January 2010 and December 2015, were retrospectively analyzed. Among them, 17 cases were diagnosed as type III, five cases were type IV, and three cases were type V. The surgery mainly included three main steps: bone flap incision, drilling in the clavicle, and hook plate fixation and AC joint reposition. The treatment efficacy was evaluated through clinical examinations and imaging studies for the shoulder joint, including gross observation and measuring coracoid clavicle distance (CC‐Dist) using orthophoria X‐ray before and 1 year after the surgery, and University of California (UCLA) shoulder rating scale.ResultsAll the patients were followed up three to four times in 18 months (12–24 months) on average, and the UCLA rating results showed that there were 17 excellent cases (68%), five good cases (20%), and three fair cases (12%). The CC‐Dist values after the surgery reduced to 9.7 ± 0.7 mm, which was significantly (P < 0.05) lower compared to that before the surgery (15.8 ± 1.6 mm). Most (88%) of the cases showed almost normal joint function and good anatomical arrangement of the acromioclavicular joint, without any secondary dislocation, and for them, 12 ± 2 weeks on average were needed to regain the normal function of shoulder joint movement.ConclusionDue to the stable fixation, fewer complications, and satisfactory therapeutic effect with great clinical value, the combination of AO CHP and CC ligament transposition is expected to be used for treating Rockwood III‐V dislocation of AC joint.     

不稳定性锁骨外侧端骨折及肩锁关节脱位的手术治疗

目的　评价不稳定性锁骨外侧端骨折及肩锁关节脱位的治疗方法和临床疗效。方法　对 1 0 9例不稳定性锁骨外侧端骨折及肩锁关节脱位患者分别行手术切开复位克氏针内固定、克氏针张力带内固定与锁骨钩钢板内固定治疗。平均随访时间 1 5年 ,采用Karlsson评分标准评估治疗效果。结果　优良率为 80 7% (88/1 0 9) ,其中克氏针内固定组优良率为 73 8% ,克氏针张力带内固定组优良率为 78 9% ,锁骨钩钢板内固定组优良率为 93 1 % ;前两组与后一组相比较 ,有显著性差异 (P <0 0 5 ) ,锁骨钩钢板内固定组优良率最高。结论　对不稳定性锁骨外侧端骨折及肩锁关节脱位 ,锁骨钩钢板内固定疗效最佳 ,对新鲜骨折脱位手术中不一定要修复喙锁韧带、肩锁韧带     

Comparison of the Tight Rope Technique and Clavicular Hook Plate for the Treatment of Rockwood Type III Acromioclavicular Joint Dislocation

Aim: Acromioclavicular joint dislocation is one of the most common shoulder problems and may lead to instability or degenerative changes. The aim of this study was to compare the clinical outcomes of the Tight Rope system and clavicular hook plate for Rockwood type III acromioclavicular joint dislocation in adults. Materials and Methods: This was a prospective, randomized study in a hospital setting. From January 2012 to December 2014, 69 patients with type III injury were reviewed. Patients were randomly divided into two groups: Group A was treated using the TightRope system and Group B with the clavicular hook plate. All participants were followed up for 12 months. Clinical outcomes, radiological results and postoperative complications were recorded. Results: The length of incision was significantly shorter in Goup A than that in Group B. The blood loss of surgery was significantly less in the Group A. Significant difference could be found between the two groups regarding the Visual Analogue Scale scores one day after surgery, at the 3 and 12 months follow-up. There were no differences according to the improvement of the Constant–Murley score and the coracoclavicular distance between the groups. Conclusions: The two groups have similar clinical and radiological outcomes. Both treatments could relieve the pain of dislocation, improve the function of Acromioclavicular joint and rectify the coracoclavicular distance measured in plain films. However, the TightRope system exhibited some advantages in terms of length of incision, blood loss of surgery, the pain postoperatively and no need for a second surgery.     

掌长肌腱重建喙锁韧带治疗肩锁关节脱位(附24例分析)

目的　观察掌长肌腱在重建喙锁韧带治疗肩锁关节脱位中的应用疗效。方法　本组 2 4例均为Allman分型中的Ⅲ度损伤 ,全部采用取同侧掌长肌腱重建喙锁韧带 ,再用两枚克氏针交叉固定肩锁关节治疗 ,术后三角巾悬吊固定 4周 ,8周后拔除克氏针。结果　经 1 0个月～ 3年的随访 ,根据Karlsson疗效评价标准 :A级 2 0例 ,B级 4例。病人均能正常的工作、生活。结论　掌长肌腱是重建喙锁韧带良好的自身材料 ,该方法操作简单、创伤小、固定牢固、可早期活动 ,是治疗肩锁关节脱位的有效方法。     

锁骨钩钢板治疗肩锁关节脱位

目的：探讨锁骨钩钢板治疗肩锁关节脱位疗效。方法：用锁骨钩钢板治疗16例TossyⅢ型肩锁关节脱位,术后随访3-18个月。结果：随访肩关节活动基本正常,无钢板断裂,螺钉松动和再脱位。结论：锁骨钩钢板治疗肩锁关节脱位操作简单,创伤小,疗效满意。     

Minimally Invasive Coracoclavicular Ligament Augmentation With a Flip Button/Polydioxanone Repair for Treatment of Total Acromioclavicular Joint Dislocation

Treatment of complete acromioclavicular joint disruption remains controversial and ranges from rehabilitation to extensive surgical reconstruction. However, high-grade injuries (type IV, V, and VI) are typically treated surgically. Most reconstruction techniques addressing these injuries selectively focus on coracoclavicular ligament augmentation because it has been shown to be the primary stabilizer of the acromioclavicular joint. The conventional coracoclavicular polydioxanone (PDS) loop, which is widely performed, has been detected to have some pivotal disadvantages, including anterior subluxation of the clavicle, extensive preparation of the coracoid, and bony avulsion of the clavicle as a result of rotational clavicle movement. Therefore we present an augmentation technique that reduces these complications by replicating the orientation of the native coracoclavicular ligament complex and providing a minimally invasive subcoracoid and clavicular fixation of a double PDS loop by use of 2 flip buttons, typically used for extracortical anterior cruciate ligament graft fixation. The key step of the procedure includes the anatomic, secure, and stable placement of the double PDS cerclage under the coracoid base transferring a flip button through a coracoid bone tunnel. Our clinical experience shows that the presented technique is easy to perform and has a comparable invasiveness to recently presented arthroscopic techniques.     

锁骨钩钢板与Endobutton袢钢板治疗肩锁关节脱位

目的比较研究锁骨钩钢板与Endobutton袢钢板治疗肩锁关节脱位。方法 60例肩锁关节脱位的患者,38例采用锁骨钩钢板内固定,22例采用Endobutton袢钢板内固定。回顾性分析比较手术时间、术中出血量、术后并发症、术后肩关节功能评分。结果术后平均随访18个月,锁骨钩钢板在手术时间、术中出血量方面优于Endobutton袢钢板,但是术后并发症多于Endobutton袢钢板。肩关节功能评定,Endobutton袢钢板优良率97.3%,锁骨钩钢板组77.4%。结论 Endobutton袢钢板与锁骨钩钢板在治疗上总体相当,术后并发症少于锁骨钩钢板,术后肩关节功能显示有明显优势。     

Clavicular Tunnel Complications after Coracoclavicular Reconstruction in Acute Acromioclavicular Dislocation: Coracoid Loop versus Coracoid Tunnel Fixation

BackgroundThe purpose of this study was to compare clavicular tunnel complications after coracoclavicular (CC) reconstruction between a coracoid loop fixation group and a coracoid tunnel fixation group. We hypothesized that clavicular tunnel complications would be more common in the coracoid loop group.MethodsThis retrospective study evaluated 24 patients who underwent CC reconstruction using coracoid tunnel fixation (n = 14) and coracoid loop fixation (n = 10). Radiographic measurements included the CC distance and clavicular tunnel diameter. Clavicular tunnel complications such as tunnel widening and clavicular tunnel fractures were investigated. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons Shoulder score and the University of California at Los Angeles Shoulder score.ResultsThe mean follow-up period was 17.5 months (range, 11–38 months). The final clavicular tunnel diameter and the increase in the clavicular tunnel diameter in millimeter and percentage were significantly greater in the coracoid loop group than in the coracoid tunnel group (all p < 0.05). Clavicular tunnel widening more than 100% was found in 5 patients, all belonging to the coracoid loop group. Clavicular tunnel fractures occurred in 3 patients (all in the coracoid loop group). Fracture was associated with severe tunnel widening (more than 100% increase). The mean value of the final clavicular tunnel diameter in patients with fractures was significantly larger than that in patients without (12.7 ± 3.3 mm vs. 8.4 ± 1.5 mm, p = 0.016).ConclusionsClavicular tunnel complications such as significant tunnel widening and fractures after CC reconstructions in acromioclavicular dislocations were common with the coracoid loop fixation technique. A greater clavicular tunnel widening and resultantly enlarged tunnel diameter might increase the risk of fracture through the clavicular tunnel.