CAJ | 학술논문

背景：锁骨中段骨折合并肩锁关节脱位是一种罕见的损伤，目前对其内固定治疗方法尚无统一意见。 　　目的：探讨锁骨中段骨折合并肩锁关节脱位这种罕见损伤的治疗方案。 　　方法：回顾性分析2005至2011年收治的3例锁骨中段骨折合并肩锁关节脱位患者，分别采用锁骨解剖锁定钢板+钢丝喙突下环扎、锁骨解剖锁定钢板+锁骨钩钢板、锁骨解剖锁定钢板+双Endobutton钢板重建喙锁韧带的方法行内固定。比较3种方案的治疗效果，包括手术时间、出血量及肩关节功能评估等。 　　结果与结论：1例病例漏诊，仅诊断为锁骨中段骨折。3例病例均得到12个月以上的门诊随访，骨折全部愈合，分别在内固定后12，9，11个月后取出内固定，病例3的Endobutton钢板未取，取出内固定后无再脱位发生。在患者取出内固定前及取出内固定后对疼痛、日常功能、活动度及肌力进行综合评估，3例患者取出内固定前评分分别为64，71和92，取出内固定后评分分别为68，79和95。使用双Endobutton钢板结合锁骨锁定钢板治疗的病例功能恢复最好。提示双Endobutton钢板结合锁骨钢板是治疗锁骨中段骨折伴肩锁关节脱位的理想内固定选择。
배경：쇄골중단골절합병견쇄관절탈위시일충한견적손상，목전대기내고정치료방법상무통일의견。 　　목적：탐토쇄골중단골절합병견쇄관절탈위저충한견손상적치료방안。 　　방법：회고성분석2005지2011년수치적3례쇄골중단골절합병견쇄관절탈위환자，분별채용쇄골해부쇄정강판+강사훼돌하배찰、쇄골해부쇄정강판+쇄골구강판、쇄골해부쇄정강판+쌍Endobutton강판중건훼쇄인대적방법행내고정。비교3충방안적치료효과，포괄수술시간、출혈량급견관절공능평고등。 　　결과여결론：1례병례루진，부진단위쇄골중단골절。3례병례균득도12개월이상적문진수방，골절전부유합，분별재내고정후12，9，11개월후취출내고정，병례3적Endobutton강판미취，취출내고정후무재탈위발생。재환자취출내고정전급취출내고정후대동통、일상공능、활동도급기력진행종합평고，3례환자취출내고정전평분분별위64，71화92，취출내고정후평분분별위68，79화95。사용쌍Endobutton강판결합쇄골쇄정강판치료적병례공능회복최호。제시쌍Endobutton강판결합쇄골강판시치료쇄골중단골절반견쇄관절탈위적이상내고정선택。
BACKGROUND:Combination of mid-third clavicle fracture with acromioclavicular joint dislocation is a rare injury. The internal fixation treatment of this injury remains controversial. OBJECTIVE:To investigate the treatment of a rare injury of mid-third clavicle fracture combined with acromioclavicular joint dislocation. METHODS:Three patients with mid-third clavicle fracture with acromioclavicular joint dislocation from 2005 to 2011 were analyzed retrospectively. The three patients were treated with clavicle anatomic locking plate+wire subcoracoid cerclage, clavicle anatomic locking plate+clavicular hook plate and clavicle anatomic locking plate+dual Endobutton plate coracoclavicular ligament reconstruction, respectively. The treatment effects of these three methods were compared, including the operation time, blood loss, and the shoulder function evaluation. RESULTS AND CONCLUSION:One case was misdiagnosed as simple mid-third clavicle fracture. Al the three patients were fol owed-up for more than 12 months, and the clavicle fracture healed in al three cases. The internal fixators were moved out at 12, 9 and 11 months, the Endobutton plate was stil in the body, and no redislocation happened in al cases. The pain, daily function, activity and muscle strength were compressively assessed before and after internal fixator removal. The scores of the three patients were 64, 71 and 92 before surgery, and 68, 79 and 95 after surgery. Patient treated with double Endobutton and locking plate had the best recovery. Double Endobutton plus clavicle plate are good choice as internal fixation in the treatment of mid-third clavicle fracture combined with acromioclavicular joint dislocation.