锁骨钩钢板治疗新鲜NeerⅡ型锁骨远端骨折及TossyⅢ型肩锁关节脱位

目的总结锁骨钩钢板内固定治疗新鲜NeerⅡ型锁骨远端骨折及TossyⅢ型肩锁关节脱位的手术方法及临床疗效。方法 2004年8月～2008年10月,应用锁骨钩钢板治疗28例NeerⅡ型锁骨远端骨折和21例TossyⅢ型肩锁关节脱位,术中仅行锁骨钩钢板固定,未刻意修复喙锁韧带、喙肩韧带。术后X光片评估锁骨骨折愈合及肩锁关节脱位的复位,根据Constant-Murley评分系统评价肩关节功能康复情况。结果手术后复查X线片示锁骨远端骨折及肩锁关节均完全复位。患者均获随访,随访12～48月,平均14.9月,均提示锁骨远端骨折愈合、无螺钉松动、钢板或钩部折断。术后8～18月内固定取出后,无肩锁关节再脱位。2例术后4个月患肩活动过大时明显感肩部酸痛不适,8月后取出钢板后症状消失。随访终末,所有患者Constant-Murley评分平均为89.6分（83～92分）。结论采用锁骨钩钢板内固定治疗新鲜NeerⅡ型锁骨远端骨折及TossyⅢ型肩锁关节脱位,具有复位简单、固定确切、肩关节可以早期活动、肩关节功能恢复好等优点。

Treatment of acute Neer type Ⅱ distal clavicular fracture and Tossy type Ⅲ acromioclavicular dislocation with clavicular hook plate

Objective To evaluate the operative procedure and the clinical results of the clavicle hook plate in patients with a Neer type Ⅱ distal clavicle fracture and Tossy type Ⅲ acromioclavicular dislocation.Methods Twenty-eight patients with acute Neer type II distal clavicle fractures and Twenty-one patients with acute Tossy type III acromioclavicular joint dislocations were treated with the clavicle hook plate between August 2004 and December 2008. All patients were open reduction and internal fixation with the clavicle hook plate. The coracoclavicular ligaments or/and acromiocoracoid ligament were not sutured. Postoperative radiographs of clavicles were used to assess bony union and disolcated reduction. Functional recovery of the shoulder joint was assessed using the Constant-Murley scoring system. Results All patients had radiographic bony union and disolcated reduction after operation. The mean follow-up period was 14.9 months（12～48 months）.All Clavicle fractures eventually achieved solid bony union. There were no plate or hook breakage and screw looseness. There were not acromioclavicular redislocation after removal of clavicular hook plate between postoperative 8 months and 18 months. Two cases accepted hook plate removal after postoperative 8 months because of obvious shoulder＇s pain in the postoperative 4 months. Clinical results were excellent with a mean Constant-Murley score of 89.6 points（range,83～92 scores）at final follow-up. Conclusion Clavicular hook plate are useful fixative implants for acute Neer type Ⅱ distal clavicle fractures and acute Tossy type Ⅲ acromioclavicular joint dislocations,ensuring easy reduction and immediate stability and allowing early mobilization with good functional and cosmetic results.