钩钢板取出后肩锁关节影像学变化及取出的必要性

背景：目前对钩钢板的研究主要集中于内固定后阶段的效果及并发症,而内固定取出后出现的症状及相应影像学变化提及甚少。 目的：探讨钩钢板取出后的症状、影像学变化及内固定取出的必要性。 方法：选择2009-01/2011-01解放军第101医院骨科收治的采用钩钢板固定治疗Neer Ⅱ型锁骨远端骨折及TossyⅢ型肩锁关节脱位患者87例,其中男54例,女33例;年龄20~61岁,平均39.8岁。取出内固定后均行常规的X射线片检查,并用Constant-Murley评分系统评定取出内固定前、后的肩关节功能。 结果与结论：87例均获随访,随访时间8~18个月。均于12周左右取出内固定。患者伤口愈合佳,未出现感染、内固定断裂、钢板脱钩松动等现象。内固定取出后Constant-Murley评分高于取出前(P < 0.001),但有8例取出后评分较取出前降低,取出后X射线片表现主要为：骨吸收征象、肩锁关节炎、肩峰退变等。X射线片表现解释了取内固定前评分较低的原因,能作为诊断的依据并指导取出后的临床治疗;建议在肩周韧带(喙锁韧带及肩锁韧带)愈合后应及时取出内固定。

Imaging changes of acromioclavicular joint after removing hook plate and the necessity of hook plate removal

BACKGROUND:Now the studies on hook plate are mainly the curative effect and complications after internal fixation, but studies about symptoms and corresponding imaging changes after removing internal fixation are rarely. OBJECTIVE:To discuss the symptoms and imaging changes after removing hook plate and the necessity of removing hook plate. METHODS:Totally of 87 patients with the hook plate for the treatment of Neer Ⅱ type of distal clavicle fractures and Tossy Ⅲ type acromioclavicular joint dislocation were selected from Department of Orthopedics, the 101 Hospital of Chinese PLA between January 2009 and January 2011. There were 54 males and 33 females, aged 20-61years old with the average age of 39.8 years. All the patients were taken conventional X-ray after the hook plate removal. Shoulder joint function was tested by using Constant-Murley score system before and after the hook plate removal. RESULTS AND CONCLUSION:All the 87 patients were followed-up for 8 to 18 months. The hook plate was removed at about 12 weeks. Wound healing was well and without infection, fixation fracture and hook loosening. Constant-Murley score after the hook plate removal was significantly increased as compared with that before removing the plate (P < 0.001), except 8 cases were opposite which corresponding X-ray films were mainly represented bone absorption, acromioclavicular arthritis and acromion degeneration. The X-ray films explained why the score in the eight cases was opposite and this could be regarded as the diagnostic criteria to guide clinical treatment after removing fixation. It is recommended that the fixation should be timely removed after the shoulder ligaments (acromioclavicular ligament coracoclavicular ligament) healing.