锁骨钩钢板与张力带治疗肩锁关节脱位的比较分析
【摘要】 目的 比较锁骨钩钢板与张力带固定治疗肩锁关节脱位的临床效果。方法 选择我院48例肩锁关节完全脱位，采用锁骨钩钢板治疗25例；采用克氏针结合钢丝张力带固定23例。随访时间6～18个月，平均12个月。根据术后X 线片和关节功能恢复情况评定疗效。结果 根据术后X 线片和关节功能恢复情况评定疗效，局部功能评定参照Lazcano 标准进行评价。发现锁骨钩钢板治疗组和克氏针张力带组优良率分别为100％和73.9％，两组间比较差异有统计学意义(P＜0.05) 。结论 应用锁骨钩钢板是治疗肩锁关节脱位较理想的方法之一，固定可靠，可以早期功能锻练，疗效满意。
【Abstract 】 Objective
To compare the therapy of using hook-plate and k-wire tension band fixation to treat acromioclavicular joint dislocation.Methods 48 cases with acromioclavicular joint dislocation, 25 cases of them were treated with hook-plate combing, other 23 cases were treat ad with k-wire tension band combing. All cases were followed up from 6 to 18 months ，the average of 12 months. Results According to X-ray postoperative recovery of joint function and local function were used Lazcano grading system. 25 cases(100%) were excellent and good in hook-plate group. 17cases(73.9%) in k-wire tension band group. The statistics analysis showed that there had difference between hook-plate group and k-wire tension band group (P＜005).Conclusion Using hook-plate to treat acromioclavicular dislocation can provide reliable fixation and allow early functional excises so that the effects are satisfactory.
【Key words】
Hook-plate ；K-wire tensiou band；Acromioclaviular joint；Dislocation
肩锁关节脱位按Tossy 等级分为Tossy I、Ⅱ、Ⅲ型［1］，Tossym Ⅲ型肩锁关节脱位为全脱位。以往使用克氏针或螺钉固定治疗，不仅并发症多，而且很难达到满意的治疗效果，我们对48例肩锁关节脱位患者分别应用克氏针钢丝张力带固定术和锁骨钩钢板固定术进行治疗现将两种治疗方法的疗效对比如下。
1 资料与方法
1.1 一般资料 本组48例，采用锁骨钩钢板内固定25例，克氏针张力带内固定23例。男30例，女18例，年龄24～62岁，平均46岁。48例均为新鲜脱位，所有病例均未合并血管及神经损伤，术前X 线片显示肩锁关节完全分离。受伤距住院时间0～5 d，平均1～2 d。
1.2 手术方法 克氏针钢丝张力带组：臂丛麻醉下，取肩峰上沿锁骨外端转向喙突弧形切口，长约8 cm。清理关节内血肿和破裂的软骨盘。距锁骨外端约2 cm 处从前向后横钻一小骨孔，穿过细钢丝预留。直视下推压锁骨远端使之完全复位，用2枚克氏针于肩峰下3～5 mm 向锁骨外端髓腔中钻入交叉固定，将钢