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切开复位内固定治疗锁骨双极脱位四例

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目的 总结切开复位内固定治疗4例锁骨双极脱位的方法及疗效.方法 2017年6月-2022年6月,收治4例锁骨双极脱位患者.男3例,女1例;年龄27~63岁,平均45岁.致伤原因:矿车挤压伤2例,交通事故伤1例,重物砸伤1例.受伤至手术时间为3~7 d,平均5.0 d.胸锁关节脱位分型:Grade Ⅱ型1例,Ⅲ型3例;前脱位3例,后脱位1例.肩锁关节脱位分型:TossyⅡ型2例,Ⅲ型2例.均行切开复位内固定术,胸锁关节、肩锁关节分别采用外踝锁定钛板、锁骨钩钢板固定.结果 4例手术均顺利完成,无血管、神经损伤;术后切口均Ⅰ期愈合.患者均获随访,随访时间12~18个月,平均14个月.末次随访时,肩关节功能根据Rockwood评分法评定,获优3例、良1例.随访期间无内固定物松动、断裂发生.4例均于术后5~7个月二次手术取出内固定物,平均6个月;取出后无关节再脱位发生.结论 锁骨双极脱位切开复位后,以外踝锁定钛板固定胸锁关节、锁骨钩钢板固定肩锁关节,具有手术操作简便、安全性高、固定牢固、并发症少等优势,患者肩部功能恢复较好.
Open reduction and internal fixation in treatment of four cases of bipolar clavicle dislocations
Objective To summarize the method and effectiveness of open reduction and internal fixation in the treatment of 4 cases of bipolar clavicle dislocations.Methods Between June 2017 and June 2022,4 patients with bipolar clavicle dislocations were admitted.There were 3 males and 1 female.The age ranged from 27 to 63 years,with an average age of 45 years.There were 2 cases of crushing injury of mine car,1 case of traffic accident injury,and 1 case of heavy object injury.The time from injury to operation was 3-7 days,with an average of 5.0 days.The sternoclavicular joint dislocations were classified as Grade Ⅱ in 1 case and type Ⅲ in 3 cases,and anterior dislocation in 3 cases and posterior dislocation in 1 case.The acromioclavicular joint dislocations were classified as Tossy type Ⅱ in 2 cases and type Ⅲ in 2 cases.After open reduction,the sternoclavicular joint and acromioclavicular joint were fixed with lateral malleolus locking titanium plate and clavicular hook plate,respectively.Results All operations were successfully completed without vascular or nerve injury.All incisions healed by first intention.All patients were followed up 12-18 months,with an average of 14 months.At last follow-up,the shoulder joint functions were rated as excellent in 3 cases and good in 1 case according to Rockwood score.During follow-up,there was no loosening of internal fixator or fracture.The internal fixators were removed in all patients at 5-7 months after operation(mean,6 months),and no re-dislocation occurred after removal.Conclusion For bipolar clavicle dislocation,open reduction combined with lateral malleolus locking titanium plate fixation of the sternoclavicular joint and clavicle hook plate fixation of the acromioclavicular joint can achieve good effectiveness.It has the advantages of simple operation,high safety,firm fixation,and fewer complications,and the shoulder function recovers well.

Bipolar clavicle dislocationsternoclavicular jointacromioclavicular jointopen reductioninternal fixation

高培刚、王兴存、鲍红刚

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中国人民解放军中部战区空军医院骨科(山西大同 037006)

锁骨双极脱位 胸锁关节 肩锁关节 切开复位 内固定

2024

中国修复重建外科杂志
中国康复医学会,四川大学华西医院

中国修复重建外科杂志

CSTPCD北大核心
影响因子:1.239
ISSN:1002-1892
年,卷(期):2024.38(2)
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