CAJ | 학술논문

目的：探讨锁骨钩钢板治疗肩锁关节脱位术后并发骨折的原因。方法对2008~2014年在我院行锁骨钩钢板治疗肩锁关节脱位的73例患者进行了回顾性研究，对其中6例并发锁骨骨折进行分析探讨。结果总结出8种可能致并发锁骨骨折的原因：(1)再受伤及功能锻炼不当；(2)肩锁关节微动限制；(3)钢板塑形不佳；(4)钢板选择过短；(5)断裂的喙锁韧带未修补；(6)术中多次重复钻孔；(7)内固定保留时间过长；(8)各种原因所致的骨质疏松。结论锁骨钩钢板治疗肩锁关节脱位具有操作简便、手术创伤小、费用合理，允许患者早期肩关节功能锻炼等优点，术后并发锁骨骨折应在术前计划、术中操作及术后管理方面加以防范及重视，即可能有效避免。
목적：탐토쇄골구강판치료견쇄관절탈위술후병발골절적원인。방법대2008~2014년재아원행쇄골구강판치료견쇄관절탈위적73례환자진행료회고성연구，대기중6례병발쇄골골절진행분석탐토。결과총결출8충가능치병발쇄골골절적원인：(1)재수상급공능단련불당；(2)견쇄관절미동한제；(3)강판소형불가；(4)강판선택과단；(5)단렬적훼쇄인대미수보；(6)술중다차중복찬공；(7)내고정보류시간과장；(8)각충원인소치적골질소송。결론쇄골구강판치료견쇄관절탈위구유조작간편、수술창상소、비용합리，윤허환자조기견관절공능단련등우점，술후병발쇄골골절응재술전계화、술중조작급술후관리방면가이방범급중시，즉가능유효피면。
Background Dislocation of the acromio-clavicle (AC)joint is a common injury, accounting for 12% of shoulder girdle injuries.According to Rockwood classification,type Ⅰ and ⅡAC injuries prefer to conservative treatment;type Ⅳ-Ⅵ injuries are good indications for surgical treatment.Operative treatment for type Ⅲ injury is still controversial.Hook plate has been used by many surgeons as an internal fixation device to maintain the reduced AC joint in place.There are some complications that may occur in some cases,such as implant failure,loss of reduction and secondary clavicle fracture.This study is designed to evaluate the clinical outcome of patients treated by hook plate and explore the cause of secondary clavicle fracture.Methods From January 2008 to January 2014,73 patients who sustained clavicle fracture was operated and fixed by hook plate.The operation was performed under general anesthesia or regional cervical plexus nerve block.The incision was from distal third of clavicle down to corocoid.The acromial clavicular joint,distal third of clavicle,corocoid and corococlavicular ligament were exposed.Debridement of AC joint was performed and cartilage debris was removed.Corococlavicle ligament was explored and sutures were preload in the ligament. Acromial clavicular joint dislocation was reduced and proper hook plate was chosen.The plate was fixed by screws and sutures were tied.The acromial clavicular capsule was repaired.The wound was closed layer by layer.Post-operative care:the shoulder was protected in a sling for 3 weeks.Pendulum exercise began immediately after operation.Passive motion could be started as pain be tolerated. Results Seventy-three patients were included in this study.There were 47 males and 26 females.The patients suffered from fall in 37 cases,traffic accident in 1 7 cases and hit on the shoulder in 1 9 cases. According to Rockwood classification,type Ⅲ in 61 cases,type Ⅳ in 12 cases.The follow up time was from 1 to 34 months.Six patients sustained secondary clavicle fracture.Secondary fracture occurred at 32,47,63,98,186,356 days after primary operations respectively.One of 6 patients fractured by additional trauma.The secondary fracture rate was 8%.Eight possible causes can be concluded from this study:(1 )unlimited shoulder motion or re-injury;(2 )tight fixation of the AC joint increases stress at the medial side of the clavicle;(3)the hook plate is not anatomical plate;(4) the plate is too short;(5)corococlavicle ligament was not repaired;(6)re-drill on the clavicle decreases biomechnical properties of the bone;(7)the implant was not removed in time;(8)osteoporosis of the distal clavicle.Discussion Hook plate is a good implant for acromial clavicular joint dislocation.It has many advantages, such as not technical demanding, limited invasive, early rehabilitation. This procedure has low complication rate and good clinical outcome.Secondary clavicle fracture after hook plate fixation has been reported rarely.This study discussed eight possible causes of this complication. Most of the causes can be avoided by detailed pre-operative planning,careful intra-operative repair and proper post-operative rehabilitation.