锁骨钩钢板治疗锁骨远端骨折及肩锁关节脱位张成1张雁2张成1张雁2(1山东省淄博市博山区医院255200；2山东珑山实业有限公司医院255200)【摘要】目的对锁骨钩钢板治疗锁骨远端骨折及肩锁关节脱位进行初步探讨。方法对近年来24例锁骨钩钢板治疗锁骨远端骨折及肩锁关节脫位经验进行总结。术前体检发现肩关节肿胀和疼痛，局部隆起、钢琴征(Pianosign)阳性，X射线片示NeerII型锁骨骨折20例,TossyIII型肩锁关节脱位4例。术中取锁骨切口将锁骨远端骨折及肩锁关节脱位复位，用锁骨钩钢板固定。结果术后随访6个月~3年零6个月，平均18个月。所有患者术后1周均能进行肩关节主动活动，书后6周基本恢复日常生活和工作。随访的X线片示平均骨折愈合时间约12周，未见骨折不愈合、肩锁关节半脫位、钢板断裂、松动及脱钩等现象。结论锁骨钩钢板治疗锁骨远端骨折及肩锁关节脱位，疗效确切，有重要的使用价值。【关键词】锁骨远端骨折锁骨关节脱位锁骨钩钢板【中图分类号】R687【文献标识码】A【文章编号】1672-5085(2014)24-0039-02【Abstract]thegoalcarriesonthepreliminarydiscussiontothecollarbonehooksteelplatetreatmentcollarbonefar-endbonefractureandthearticulatioacromioclavicularisdislocation.Themethodcarriedonthesummarytotherecentyears24examplecollarbonehooksteelplatetreatmentcollarbonefar・endbonefractureandthearticulatioacromioclavicularisdislocationexperience」nfrontofthetechniquethephysicalexaminationdiscoveredshoulderjointswellingandache,blister,thepianodraft(Pianosign)themasculinegender,XbeampieceshowsNeerIICollarbonebonefracture20examples,TossylllArticulatioacromioclavicularisdislocation4examples」nthetechniquetakesthecollarbonemarginthecollarbonefar-endbonefractureandthearticulatioacromioclavicularisdislocationreplacement,isfixedwiththecollarbonehooksteelplate.Afterfinallythetechniquemakesafollow-upvisit6monthfor~3years6months,theaverage18months.Theallpatienttechniquelatter1weekcancarryontheshoulderjointinitiativeactivity,thebooklatter6weeksrestoresthedailylifeandtheworkbasically.TherevisitXpieceshowstheaveragebonefracturecicatrizationtimeapproximately12weeks,hasnotseenthebonefracturenottoheal,thearticulatioacromioclavicularishalfdislocation,thesteelplatebreak,becomeslesscrowdedandgetsunhookedandsoonthephenomena.Theconclusioncollarbonehooksteelplatetreatmentcollarbonefar-endbonefractureandthearticulatioacromioclavicularisdislocation,thecurativeeffectisaccurate,hastheimportantusevalue.【keyword]collarbonefar-endbonefracturecollarbonejointdislocationcollarbonehooksteelplate肩锁关节脱位及锁骨远端骨折临床较为多见，锁骨远端骨折-•般为直接暴力所致，肩锁关节脱位多有暴力自上向下作用于肩峰引起。现报告如下。1资料与方法1.1一般资料24例中男16例，女8例；年龄18^54岁，平均38岁。左侧13例，右侧口例。车祸伤16例，跌伤8例。8例位NeerII型锁骨远端骨折，16例为Tossylll型肩锁关节脫位。伤后患肩局部隆起、钢琴征(pianosign)阳性，肿胀、疼痛，外展活动受限。1.2手术方法在颈从麻醉下，取仰卧位，患肩后方垫高，头部转向健侧，切口为肩部沿锁骨弧形至肩峰外端少偏后，切开皮肤及皮下组织，显露骨折端、肩锁关节、肩峰、喙突，清除骨折端间血肿，复位骨折端及脱位。在肩峰后外上方定位，钻孔，然后将钢板的钩由内向外插入肩峰孔内，钢板部用螺丝钉固定在锁骨近折端。锁骨远端粉碎严重骨块用可吸收线捆扎后不予固定。用可吸收线缝和修补断裂的喙锁韧带及关节囊。2结果随访病例24例，随访吋间6个月~3年零6个月，平均8个月。所有患者术后1周均能进行肩关节主动活动，术后6周基本恢复日常生活和工作。1例肩部肿胀消退后皮下可扪及钩尖，伴压痛，3例有异物感。随访的x线片平均骨折愈合时间约12周，未见骨折不愈合、肩锁关节半脱位、钢板断裂、松动及脫钩等现象...