钢板联合镜下喙锁韧带重建治疗锁骨外侧端骨折

发布时间：2018-08-12 13:40

【摘要】：[目的]探讨锁骨外侧端骨折治疗方法。[方法]使用解剖锁定钢板联合镜下喙锁间固定治疗Neer IIB型锁骨外侧端骨折,采用侧卧位,患侧上臂外展前屈位牵引,制作关节镜后侧入路及前上入路,盂肱关节内打开肩袖间隙,显露喙突根部下表面,然后锁骨上表面皮肤横行切开,显露锁骨外侧骨折端,清理骨折端,复位并临时固定,预放置钢板并记录,插入导向器,打入导针,拉入袢钢板,使袢钢板卡于喙突下,袢从锁骨骨道上方拉出,穿入预选钢板,解除骨折端临时固定,旋转钢板调整骨折复位,旋入螺丝钉固定。[结果]8例患者术后平均随访10个月,骨折均愈合,平均愈合时间4.5个月(2.5~6个月)。术前喙锁间平均距离21.5 mm,术后平均10.9 mm,与健侧对比无明显增加,肩锁关节间隙无增宽及骨性关节炎表现。患肩活动度与健侧对比没有明显差异。[结论]本固定技术具有微创、固定牢固、康复快、美观、满意度高等优点,同时可处理盂肱关节内合并伤,无需取出内固定,临床效果满意,并发症率低。
[Abstract]:Objective to investigate the treatment of lateral clavicle fracture. [methods] the lateral clavicle fracture of Neer IIB type was treated with anatomic locking plate combined with coracoclavicular fixation under microscope. The lateral position was used and the lateral flexion of the affected upper arm was used to make the posterior and anterior superior approach of arthroscopy. The glenohumeral joint opened the rotator cuff space, exposed the coracoid root surface, then the skin of the supraclavicular surface was cut across, exposed the fracture end of the lateral clavicle, cleaned the fracture end, reduced and fixed temporarily, pre-placed the plate and recorded, inserted the guide, The loop plate was stuck under the coracoid process, and the loop was pulled out from the upper clavicle and penetrated into the pre-selected plate to release the temporary fixation at the fracture end. The rotation plate adjusted the reduction of the fracture and fixed it with screw. [results] 8 patients were followed up for an average of 10 months. The average healing time was 4.5 months (2.5 ~ 6 months). The mean distance between coracoclavicular and coracoclavicular was 21.5 mm before operation and 10.9 mm after operation. There was no significant increase in the space of acromioclavicular joint and osteoarthritis. There was no significant difference in the range of motion between the affected shoulder and the healthy side. [conclusion] this fixation technique has the advantages of minimally invasive, firm fixation, quick recovery, beautiful appearance and high satisfaction. It can also be used to treat the combined injury of glenohumeral joint without removing internal fixation. The clinical effect is satisfactory and the complication rate is low.
【作者单位】：解放军174医院暨厦门大学附属成功医院;
【分类号】：R687.3

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