重度肩锁关节脱位的手术治疗

目的比较尼龙线法、锁骨钩钢板及克氏针张力带治疗重度肩锁关节脱位和锁骨远端骨折的疗效。方法66例重度肩锁关节脱位患者，22例采用锁骨钩钢板，18例采用克氏针张力带内固定，26例采用尼龙线固定。回顾性分析比较其治疗效果及并发症。结果术后平均随访15个月，3种手术方法的优良率分别为：克氏针张力带组77．8％，锁骨钩钢板组90．9％，尼龙线组100％，3组比较差异有统计学意义（P〈0．05）。克氏针张力带固定组3例发生克氏针松动，其中2例断针并肩锁关节再脱位；锁骨钩钢板组术后出现肩峰下疼痛2例；尼龙线固定组无1例发生肩峰下疼痛或再脱位。结论锁骨钩钢板和尼龙线固定法治疗重度肩锁关节脱位比传统克氏针钢丝张力带法疗效确切。在减少并发症发生方面，尼龙线法更具优势。

Surgical Operation for Severe Dislocation of Acromioclavicular Joint

Objective To compare the therapeutic outcomes of severe acromioclavicular dislocation and terminal clavicular fracture among the methods with nylon thread, clavicular hook plate and Kirschner wire tension belt. Methods Out of 66 cases with severe acremioclavicular dislocation, 22 were treated with clavicular hook plate, 18 with Kirschner wire tension belt, and 26 with nylon thread. Retrospective analysis was done in order that the therapeutic outcomes and the complications could be compared. Results Acording to the foUow-up （mean = 15 months） , the excellence rates of the three methods were 77.8% （Kirschner wire tension belt）, 90.9% （ clavicular hook plate） and 100% （ nylon thread）, respectively, among which there existed statistical differences （ P 〈 0.05）. As a result, there were three cases with loosening of Kirschner wire in the group of Kirschner wire tension belt, two of which suffered wire breaking plus acromioclavicular redislocation： There were two cases with pain inferior to acromion in the group of clavicular hook plate. But there was neither redislocation nor pain inferior to acromion in the group of nylon thread. Conclusion It is concluded that the therapeutic approach with clavicular hook plate or nylon thread is more effective on severe acromioclavicular dislocation than that with traditional Kirschner wire tension belt. Nylon thread method gains an advantage over any of the other two, for it brings about less complications.