CAJ | 학술논문

目的分析锁骨钩钢板治疗急性锁骨远端骨折和肩锁关节脱位的并发症发生原因,探讨减少和避免并发症的对策.方法 2006年5月至2009年5月,79例接受锁骨钩钢板固定治疗的患者中78例再次手术取出钩钢板.40例在取出钩钢板时接受CT检查,以观察肩峰下骨侵蚀的形态,其中7例在3个月再行CT检查,以了解其转归.末次随访时对患肩功能进行Constant评分.结果所有病例均获得随访,随访时间12～30个月,平均13.2个月.锁骨远端骨折和肩锁关节脱位患者钩钢板存留时间分别平均为8.3个月和7.2个月,末次随访Constant评分分别平均为92分和95分.78例患者出现8种(105例次)并发症,总的并发症发生率98.7％.与锁骨钩钢板作用特点有关的并发症88例次(83.8％),医原性并发症12例次(11.4％),与锁骨钩钢板自身缺陷有关的并发症3例次(2.9％),原发疾病治疗中固有的并发症2例(1.9％).结论锁骨钩钢板的并发症发生率高.绝大多数并发症的成因与其自身作用特点有关,难以避免；可通过选用合适的内植物、提高患者依从性等减轻其严重程度.应告知患者对肩峰下骨侵蚀转归仍不清楚,以免产生医疗纠纷.医原性并发症通过严格掌握适应证和提高手术技术可避免.年轻和老年患者应慎用.设计上有改进的必要,且须尽早移除.
목적 분석쇄골구강판치료급성쇄골원단골절화견쇄관절탈위적병발증발생원인,탐토감소화피면병발증적대책.방법 2006년5월지2009년5월,79례접수쇄골구강판고정치료적환자중78례재차수술취출구강판.40례재취출구강판시접수CT검사,이관찰견봉하골침식적형태,기중7례재3개월재행CT검사,이료해기전귀.말차수방시대환견공능진행Constant평분.결과 소유병례균획득수방,수방시간12～30개월,평균13.2개월.쇄골원단골절화견쇄관절탈위환자구강판존류시간분별평균위8.3개월화7.2개월,말차수방Constant평분분별평균위92분화95분.78례환자출현8충(105례차)병발증,총적병발증발생솔98.7％.여쇄골구강판작용특점유관적병발증88례차(83.8％),의원성병발증12례차(11.4％),여쇄골구강판자신결함유관적병발증3례차(2.9％),원발질병치료중고유적병발증2례(1.9％).결론 쇄골구강판적병발증발생솔고.절대다수병발증적성인여기자신작용특점유관,난이피면；가통과선용합괄적내식물、제고환자의종성등감경기엄중정도.응고지환자대견봉하골침식전귀잉불청초,이면산생의료규분.의원성병발증통과엄격장악괄응증화제고수술기술가피면.년경화노년환자응신용.설계상유개진적필요,차수진조이제.
Object To analyze reasons of complications induced by the clavicle hook plate in treatment of acute distal clavicle fractures and acute acromioclavicular joint dislocations,and to investigate corresponding solutions.Methods Seventy nine clavicle hook plates were facilitated in the treatment of acuteb distal clavicle fractures (47 cases) and acute high grade acromioclavicular joint dislocations (32 cases) from May 2006 to May 2009.There were 51 males and 28 females,with an average age of 42.6 years(range,15 to 78 years).Seventy eight patients underwent plate removal operation.Forty patients agreed to accept the CT examination to evaluate the acromion erosion around the plates.Among them,7 patients received further CT examination 3 months after the removal surgery.The shoulder function was evaluated by the constant scores at the final follow-up.Results All patients were followed up for at least one year (range,12 to 30 months).The mean duration for retaining the hook plate was 8.3 months with the mean Constant scores 92 points in the acute distal clavicle group; 7.2 months with the mean Constant scores 95 points in the acute acromioclavicular joint dislocation group.There were 8 kinds,totally 105 complications happened in 78 patients (98.7％).The complications were classified into four groups: (1) Due to the specific working mechanism of the plate(88/105,83.8％);(2) Due to the iatrogenic errors(12/105,11.4 ％);(3) Due to insufficiency design of the plate(3/105,2.9％);(4) Due to the etiology of the injury itself(2/105,1.9％).Conclusion The complication rate is unexpected higher.Most complications are unavoidable due to specific working mechanism of the plate.The patients should be well informed about this preoperatively in order to avoid the possible legal trouble.The iatrogenic errors can be avoided with proper indications and improved surgical techniques.The design of the plate needs to be improved,and the hook plate should be removed as early as possible.