锁骨钩钢板内固定术后钢板钩与肩峰匹配性影像学研究

目的通过测量锁骨钩钢板内固定术后患者影像学资料,分析发生肩峰骨侵蚀的原因是否与钢板钩-肩峰匹配度相关。 方法回顾性分析2015年8月1日至2018年8月31日期间在上海市浦东医院骨科就诊的210例患者的影像学资料,210例患者均因肩锁关节脱位或锁骨远端骨折行锁骨钩钢板内固定治疗,其中男110例、女100例;年龄24~76岁,平均（44.60±8.75）岁;肩锁关节脱位70例,锁骨远端骨折140例。测量术后及终末随访患者肩锁关节正位X线片相关数据,按锁骨钩钢板术后是否发生肩峰骨侵蚀,将纳入患者分为3组：无骨侵蚀组（A组）、伴钢板钩移位骨侵蚀组（B组）、不伴移位的骨侵蚀组（C组）,分别测量钢板钩-肩峰的匹配度（β）,统计分析术后发生肩峰骨侵蚀与钢板钩-肩峰匹配度之间的关系。 结果纳入研究的210例患者术后随访24~64周,平均（32.0±6.5）周。A组患者115例,B组患者54例,C组患者41例。A组匹配度β（3.72±0.48）mm与B组β¹（6.91±0.84）mm比较差异有统计学意义（P<0.05）;A组匹配度β（3.72±0.48）mm与C组β²（5.88±0.65）mm比较差异有统计学意义（P<0.05）;B组匹配度β¹（6.91±0.84）mm与C组β²（5.88±0.65）mm比较差异有统计学意义（P<0.05）。 结论锁骨钩钢板内固定术后是否发生肩峰骨侵蚀与钢板钩-肩峰匹配度β存在明显相关性,钢板钩与肩峰之间的匹配度越好,β值越小,发生肩峰骨侵蚀的可能性更小。

Imaging study on the matching between plate hook and acromion after clavicular hook plate internal fixation

BackgroundClavicular hook plate has been widely used to treat acromioclavicular joint dislocation and clavicular acromion fracture since the 1970s. It has become one of the most critical methods for the treatment of this type of injury. The plate's specially designed "hook" was inserted under the acromion to reduce and fix the acromioclavicular joint dislocation and clavicular acromion fracture using the lever principle. The clavicular hook plate has sufficient fixation strength to allow early active shoulder abduction after surgery. However, the clavicular hook may slide in various degrees with the movement of the shoulder joint due to three-dimensional irregular space under the acromion. It has been confirmed by numerous literature reports that there is good clinical efficacy with few complications in the treatment of acromioclavicular joint dislocation and clavicular acromion fracture with clavicular hook plate. The abnormal sound of the shoulder joint and acromion bone erosion after operation have not yet been paid enough attention, for the symptoms are released to a greater extent after removal of internal fixators. The acromioclavicular joint is flexible, and its unique multi-dimensional activities will cause friction and cutting between the clavicular hook and acromion. Bone erosion will occur at the stress concentration point under the acromion. Many biomechanical studies on the length, angle, and height of clavicular hook plates have been reported in recent years. The research mainly focuses on the factors of the clavicular hook plate itself. There are few reports on the related complications after internal fixation due to the morphological difference of acromion. ObjectiveTo investigate the causes of acromion bone erosion in patients with distal clavicle fractures or acromioclavicular joint dislocations after internal fixation with a clavicular hook plate and determine whether it is related to the matching of plate hook and acromion. MethodsFrom August 1, 2015 to August 31, 2018, the clinical data of 210 patients with acromioclavicular joint dislocation or distal clavicle fracture treated with clavicular hook plate in the department of orthopedics, Shanghai Pudong Hospital were retrospectively analyzed. There were 110 males and 100 females, and the ages ranged from 24 to 76 years old (44.60 years±8.75 years) . There were 70 acromioclavicular joint dislocations and 140 cases of distal clavicular fractures. The relevant data were measured on the anteroposterior X-ray films of the acromioclavicular joint collected after the surgeries and final follow-ups. According to whether the acromion bone erosion occurred after clavicular hook plate fixation, the patients were divided into no bone erosion group, bone erosion with clavicular hook displacement group, and bone erosion without clavicular hook displacement group, and the matching degree (β) of plate hook-acromion was measured respectively. The relationship between acromion bone erosion and plate hook and acromion matching degree was statistically analyzed. ResultsAll patients were followed up for 24 to 64 weeks (32.0 weeks±6.5 weeks) . Group A (no acromion bone erosion group) included 115 cases, group B (bone erosion with clavicular hook displacement) included 54 cases, and group C (bone erosion without clavicular hook displacement) included 41 cases. There was a significant difference in matching degree (β) between group A (β=3.72 mm±0.48 mm) and group B (β¹=6.91 mm±0.84 mm) (P<0.05) . The matching degree of group A (β=3.72 mm±0.48 mm) was significantly different from that of group C (β²=5.88 mm±0.65 mm) (P<0.05) . There was a significant difference in matching degree between group B (β¹=6.91 mm±0.84 mm) and group C (β²=5.88 mm±0.65 mm) (P<0.05) . ConclusionAcromion bone erosion after clavicular hook plate fixation is significantly correlated with the matching degree (β) of plate hook-acromion. The better matching the plate hook and acromion is, the less the possibility of acromion bone erosion.