肩锁关节脱位重建：金属植入物的选择

目的：介绍肩锁关节脱位应用金属植入物内固定方法及其内固定物的选择，评价应用锁骨钩钢板治疗肩锁关节脱位的效果。 方法：以“锁骨钩钢板；肩锁关节脱位；内固定”为检索词，检索1996/2010 PubMed数据库、维普数据库与金属置入物置入固定肩锁关节脱位相关文献，重点探讨了肩锁关节脱位治疗方法及内固定物的选择，并进行了临床验证。应用AO/ASIF锁骨钩钢板治疗肩锁关节脱位和锁骨远端骨折、Rockwood分型Ⅲ型~Ⅴ型患者。采用Lazzcano评分标准进行功能评定。 结果：目前治疗肩锁关节脱位方法有单纯的克氏针固定法、克氏针张力带固定法、Bosworth法、喙锁间钢丝内固定、钛缆代替钢丝固定法、改良Weaver法或用肌腱、人工韧带重建喙锁韧带、锁骨钩钢板治疗法等，各有利弊。临床验证：应用AO/ASIF锁骨钩钢板治疗34例患者均获12个月的随访。未发现钢板、螺钉松动、折断情况。6~12个月内固定取出后2例出现肩锁关节半脱位，均未行喙锁韧带修复。采用Lazzcano评分标准评定优30例，良4例。 结论：锁骨钩钢板治疗肩锁关节脱位和锁骨远端骨折具有手术操作简单、固定可靠、创伤小、肩关节功能恢复快等优势。

Reconstruction of acromioclavicular joint dislocation: Selection of metal implants

OBJECTIVE:To introduce the metal implant internal fixation methods and implant selection of acromioclavicular joint dislocation, to evaluate the efficacy of clavicular hook plate in treatment of acromioclavicular joint dislocation. METHODS:Using “clavicular hook plate; acromioclavicular joint dislocation; internal fixation” as the key words, a computer-based online search of PubMed database and VIP database from 1996 to 2010 was performed for articles about metal implants fixation for the dislocation of acromioclavicular joint, focusing on the acromioclavicular joint dislocation treatments and the choice of internal fixation implant, and clinical validation was conducted. Patients who were treated with AO/ASIF clavicular hook plate for acromioclavicular joint dislocation and distal clavicle fractures in accordance with type Ⅲ-Ⅴ of Rockwood classification, were involved. Lazzcano score was applied to determine function. RESULTS:The present method of treating acromioclavicular joint dislocation includes a simple Kirschner wire internal fixation, Kirschner wire and tension band fixation, Bosworth method, coracoclavicular fixation between the wire, titanium wire cable instead of the wire fixation method, modified Weaver method, tendon or artificial ligament for coracoclavicular ligament reconstruction, clavicular hook plate and so on, each has their advantages and disadvantages. Clinical validation showed that, 34 patients after treatment of AO/ASIF clavicular hook plate were visited for 12 months as a follow-up. No plate or screw loosed and broken. At 6-12 months, the implants were taken out, 2 cases exhibited acromioclavicular subluxation, coracoclavicular ligament repair was not performed. Assessment criteria was in accordance with Lazzcano scores, 30 cases were excellent and 4 cases were good. CONCLUSION:The clavicular hook plate for acromioclavicular joint dislocation and distal clavicle fracture is a simple operation, with reliable fixation, less trauma, rapid recovery of shoulder function and other advantages.