摘要
目的:介绍应用纵形皮肤切口显露安放锁骨钩钢板,治疗锁骨外端骨折和肩锁关节脱位的临床经验。方法:自2004年7月至2006年12月,对20例患者采用纵向皮肤切口,前瞻性治疗NeerII型锁骨外端移位骨折(12例)和Rockwood III型肩锁关节脱位(8例),术后平均随访13月,以有无锁骨上神经损伤症状和UCLA肩关节功能评分法(满分35)评价效果。结果:20例患者均无切口刺痛和肩前胸上部麻木不适感觉。术后3月摄片骨折均已愈合。1例女性在术后1年取内固定时发现锁骨外端吸收呈锥状改变,但无任何症状。肩关节功能评分术后1月(20例)平均为25.3,3月(17例)提高至32.1,取内固定前(20例)为34.4,取内固定后3月(13例)为34.7。所有患者均获得优良的功能效果。结论:纵形皮肤切口能充分显露锁骨外端和肩锁关节,足以安放锁骨钩钢板,且避免损伤锁骨上神经,效果优良。
Objective： To introduce the clinical experience of distal clavicle fractures and acromioclavicular dissociation treated through a longitudinal skin incision exposure and hook-plate intemal fixation. Methods： From July 2004 to December 2006, 20 patients with displaced distal clavicle fractures （Neer type Ⅱ, 12 cases） and acromioclavicular dissociation （Rockwood grade Ⅲ, 8 cases） were prospectively treated through a 6-8cm longitudinal skin incision exposure and AO titanic hook-plate fixation. The symptoms of supraclavicular cutaneous nerve injury and shoulder functional outcomes were evaluated using UCLA scale. Results： There were no cases reported incisional tingling and numbness at shoulder-thoracic region in postoperative follow-up. Radiographic film showed bony union achieved in 3 months. One female case presented osteolysis of the distal clavicle in X-ray film at the second admittance for hook-plate removal, but no symptoms were reported. The mean UCLA shoulder scale in follow-up was 25.3 points in 1 month （20 cases）, 32.1 in 3 months （17 cases）, 34.4 in 8-12 months （before implant removal, 20 cases）, and 34.7 in 3 months after implant removal （13 cases）. Good and excellent functional outcomes were achieved in all cases. Conclusion： Longitudinal skin incision （6-8 cm） along the cervical Langer＇ s line is sufficient for exposure of hook-plate implantation for ＂distal clavicle fracture and acromioclavicle dissociation. Its main advantage includes less scar formation and avoiding iatrogenic supraclavicular nerve injury.
出处
《中国临床解剖学杂志》
CSCD
北大核心
2008年第6期687-689,共3页
Chinese Journal of Clinical Anatomy
关键词
锁骨外端骨折
肩锁关节脱位
锁骨上神经
纵形皮肤切口
锁骨钩钢板
distal clavicle fracture
acromioclavicle dissociation
supraclavicular nerve
longitudinal skin incision
hook-plate fixation
