CAJ | 학술논문

目的探讨胸锁钩钢板内固定治疗创伤性胸锁关节前脱位的作用及临床疗效.方法 2002年5月至2009年10月,采用自行设计制造的胸锁钩钢板内固定治疗创伤性胸锁关节前脱位患者66例,男47例,女19例;年龄21～68岁,平均32.6岁;左侧25例,右侧41例.受伤原因:交通伤40例,压砸伤21例,摔伤5例.根据Allman分型:Ⅲ型31例,Ⅱ型35例;其中胸锁关节前脱位合并锁骨胸骨端骨折41例.受伤至手术时间3～62 d,平均7.5 d.Rockwood等胸锁关节评分标准对患者术后功能进行评价.结果手术时间20～48 min,平均33 min;术中出血20～90ml,平均60 ml;术后无一例发生神经、血管损伤;切口均一期愈合.术后X线片及CT扫描示胸锁关节复位满意.66例患者均得到随访,随访时间12～37个月,平均17个月.末次随访时无一例患者发生胸锁关节再脱位和内固定失效.胸锁钩钢板均于术后12个月取出.Rockwood等胸锁关节评分为8～15分,平均为13.2分,其中优50例、良15例、可1例,优良率为98.5%.结论胸锁钩钢板治疗创伤性胸锁关节前脱位手术安全,固定可靠,术后能允许肩胛带早期进行功能锻炼.
목적 탐토흉쇄구강판내고정치료창상성흉쇄관절전탈위적작용급림상료효.방법 2002년5월지2009년10월,채용자행설계제조적흉쇄구강판내고정치료창상성흉쇄관절전탈위환자66례,남47례,녀19례;년령21～68세,평균32.6세;좌측25례,우측41례.수상원인:교통상40례,압잡상21례,솔상5례.근거Allman분형:Ⅲ형31례,Ⅱ형35례;기중흉쇄관절전탈위합병쇄골흉골단골절41례.수상지수술시간3～62 d,평균7.5 d.Rockwood등흉쇄관절평분표준대환자술후공능진행평개.결과 수술시간20～48 min,평균33 min;술중출혈20～90ml,평균60 ml;술후무일례발생신경、혈관손상;절구균일기유합.술후X선편급CT소묘시흉쇄관절복위만의.66례환자균득도수방,수방시간12～37개월,평균17개월.말차수방시무일례환자발생흉쇄관절재탈위화내고정실효.흉쇄구강판균우술후12개월취출.Rockwood등흉쇄관절평분위8～15분,평균위13.2분,기중우50례、량15례、가1례,우량솔위98.5%.결론 흉쇄구강판치료창상성흉쇄관절전탈위수술안전,고정가고,술후능윤허견갑대조기진행공능단련.
Objective To investigate the clinical outcomes of sternoclavicular hook plate in treatment of the anterior sternoclavicular joint dislocation. Methods A new device named sternoclavicular hook plate was devised by our team. Between May 2002 and Octorber 2009, 66 patients with sternoclavicular joint anterior dislocation were treated with the new device, among whom there were 47 males and 19 females,aged 21-68 years old (average, 32.6 years old). Twenty-one cases were caused by crush injury, 5 cases by falling and 40 cases by traffic accident. Anterior fracture-dislocation was found in 41 cases. According to the Allman system, there were 35 cases of type Ⅱ and 31 cases of type Ⅲ. Patients were evaluated with serial clinical and radiographic examinations. Rockwood score were used after the operation to assess the curative effect. Results The average operative time was 33 min (range, 20-48 min). The mean blood loss was 60 ml (range, 20-90 ml). There were no vascular or peripheral nerve injuries in the patients. All incisions healed smoothly. The X-ray and CT showed that the reduction of sternoclavicular joint and the location of internal fixation were satisfactory. All the 66 patients were followed up for 12-37 months (average, 17 months). There was no internal fixation failure, redislocation or other complications. The sternoclavicular hook plate was removed 12 months after operation. The mean Rockwood's score was 13.2 (8 to 15). There were excellent in 50cases, good in 15 cases, and fair in 1 case. Conclusion The sternoclavicular hook plate is a new, safe and liable technique for sternoclavicular fracture-dislocation. This new technique is helpful for early functional exercises.