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EFFECTIVENESS OF CLAVICULAR HOOK PLATE COMBINED WITH TRAPEZIUS MUSCLE FASCIA FOR RECONSTRUCTION OF ACROMIOCLAVICULAR AND CORACOCLAVICULAR LIGAMENTS TO TREAT COMPLETE ACROMIO-CLAVICULAR JOINT DISLOCATION

ObjectiveTo explore the effectiveness of the clavicular hook plate combined with trapezius muscle fascia for reconstruction of acromioclavicular and coracoclavicular ligaments to treat acute complete acromioclavicular dislocations. MethodsBetween January 2008 and April 2012, 66 patients with acromioclavicular dislocation were treated with the clavicular hook plate combined with trapezius muscle fascia for reconstruction of acromioclavicular and coracoclavicular ligaments in 32 cases (experimental group) and with the clavicular hook plate in 34 cases (control group). There was no significant difference in gender, age, injured side, the cause of injury, and the time from injury to operation between 2 groups (P>0.05). Visual analogue scale (VAS), Constant shoulder scores, and coracoid clavi-cledistance (CC.Dist) were measured at preoperation and at 2 years after operation. Signal/noise quotiem (SNQ) was measured by MRI at 2 years after operation. The operation complications were observed. ResultsThe patients of 2 groups obtained primary healing of incision. The morbidity of complication in experimental group (12.5%, 4/32) was significantly lower than that in control group (91.2%, 31/34) (χ2=40.96, P=0.00). All the cases were followed up 2.8 years on average (range, 2 to 4 years). VAS scores and CC.Dist significantly decreased at 2 years after operation when compared with preoperative values in the 2 groups (P<0.05). VAS scores and CC.Dist of the experimental group were significantly lower than those in the control group (P<0.05). According to Constant shoulder scores at 2 years after operation, the results were excellent in 19 cases, good in 11 cases, and general in 2 cases with an excellent and good rate of 93.75% in the experimental group; the results were excellent in 7 cases, good in 8 cases, general in 16 cases, and poor in 3 cases with an excellent and good rate of 44.11% in the control group; and significant difference was shown between 2 groups (t=2.30, P=0.03). SNQ was significantly lower in experimental group than in control group at 2 years after operation (t=55.03, P=0.00), indicating that ligament healing was better in experimental group than control group. ConclusionCompared with simple clavicular hook plate fixation, the clavicular hook plate combined with trapezius muscle fascia for reconstruction of acromioclavicular and coracoclavicular ligaments is successful in treating acute complete acromioclavicular dislocations, with the advantages of higher ligament healing, less complication, and early improvement of shoulder functions.

TRIPLE ENDOBUTTON TECHNIQUE FOR REPAIR OF CHRONIC COMPLETE ACROMIOCLAVICULAR JOINTDISLOCATIONS

【Abstract】 Objective To evaluate the early result of tri ple Endobutton technique for reconstructing coracoclavicularligament of chronic complete acromioclavicular joint dislocations. Methods Between January 2009 and June 2010, 14 patients with chronic complete acromioclavicular joint dislocations were treated with tri ple Endobutton technique for reconstructing coracoclavicular ligament. There were 10 males and 4 females with a mean age of 38.5 years (range,26-52 years). Injury was caused by traffic accident in 7 cases,by falling in 5 cases，and by bruise in 2 cases. The average time was 47 days from injury to the operation (range,29-75 days). All patients had pain and activity restriction. The X-ray films showed complete dislocation of acromioclavicular joint. According to Allman’s type, all cases were classified as III degree complete dislocations. Results At postoperation, wound healed by first intention with no early complication of infection or neurovascular injury. All patients were followed up 18.3 months on average (range,13-30 months). Acromioclavicular joint subluxation occurred in 1 patient at 1 week after operation, and no redislocation or other complication occurred in the other patients. American Shoulder and Elbow Surgeons (ASES) score was 90.8 ± 4.1 at last follow-up, showing significant difference when compared with the preoperative score (65.3 ± 4.4) (t= —17.57，P=0.00); Constant-Murley score was 91.7 ± 3.9, showing significant difference when compared with preoperative one (71.5 ± 4.6) (t=—75.02，P=0.00). The definite answer in Simple Shoulder Test (SST) averaged 9.7 (range,7-12). Conclusion The tri ple Endobutton technique for reconstructing coracoclavicular ligament is an effective method in treatment of chronic complete acromioclavicular joint dislocations. The short-term results are satisfactory.

EFFECTIVENESS COMPARISON OF TRIPLE ENDOBUTTONS AND CLAVICULAR HOOK PLATE FOR TREATMENT OF FRESH ACROMIOCLAVICULAR JOINT DISLOCATION

ObjectiveTo compare the effectiveness of triple Endobuttons and clavicular hook plate fixation in the treatment of fresh acromioclavicular joint dislocation (Rockwood type III-V). MethodsBetween February 2008 and October 2010, 40 patients with fresh acromioclavicular joint dislocation (Rockwood type III-V) were treated with triple Endobuttons in 18 cases (trial group) and with clavicular hook plate in 22 cases (control group). There was no significant difference in gender, age, disease duration, joint dislocation classification, preoperative visual analogue scale (VAS) score and Constant-Murley score between 2 groups (P gt; 0.05). ResultsAfter operation, wound healed by first intention with no early complication of infection or neurovascular injury. The patients were followed up 12-20 months (mean, 15.8 months) in trial group and 13-24 months (mean, 17.2 months) in control group. Significant differences were found in the VAS score and Constant-Murley score at the last follow-up between 2 groups (P lt; 0.05). X-ray films showed no loosening of internal fixators or hook displacement occurred. No re-dislocation was observed. ConclusionTriple Endobuttons has less shoulder pain and better shoulder motion than clavicular hook plate, so it is an effective method of treating Rockwood type III-V fresh acromioclavicular joint dislocation.

带线骨锚钉治疗Tossy Ⅲ型肩锁关节脱位

目的 总结应用带线骨锚钉内固定治疗Tossy Ⅲ型肩锁关节脱位的效果。 方法 2007 年10 月－2010 年6 月，对27 例Tossy Ⅲ型肩锁关节脱位患者应用带线骨锚钉行内固定并韧带修复治疗。男19 例，女8 例；年龄21 ～ 59 岁。运动伤11 例，摔伤10 例，交通事故伤4 例，高处坠落伤2 例。受伤距手术间8 h ～ 5 d，平均3 d。 结果 术后切口均Ⅰ期愈合，无感染、渗液等并发症发生。27 例均获随访，随访时间9 ～ 41 个月，平均20 个月。术后6 个月X 线片示肩锁关节复位良好。术后9 个月患肩关节活动范围：向前上举140 ～ 160°，后伸35 ～ 40°；外展上举160 ～ 170°，内收25 ～ 30°；上臂紧贴胸壁内旋60 ～ 70°，外旋40 ～ 45°。外展上举肌力5 级24 例，4+ 级3 例。术后9 个月根据Karlsson 等关节功能评价标准，获优21 例，良6 例，优良率为100%。 结论 应用带线骨锚钉固定肩锁关节脱位，固定可靠，有助于术后早期功能锻炼，疗效良好。

锁骨钩钢板的临床应用及并发症分析

目的 总结以锁骨钩钢板内固定治疗Neer Ⅱ型锁骨远端骨折和Tossy Ⅲ型肩锁关节脱位的临床应用效果及并发症。 方法 2005 年8 月－ 2010 年2 月，以锁骨钩钢板内固定治疗Neer Ⅱ型锁骨远端骨折20 例和TossyⅢ型肩锁关节脱位28 例，对临床应用效果及术后并发症进行回顾性分析。其中男30 例，女18 例；年龄20 ～ 64 岁，平均33.5 岁。交通事故伤36 例，坠落伤12 例。受伤至手术时间为2 ～ 10 d，平均4.5 d。 结果 术后所有患者切口均Ⅰ期愈合。48 例均获随访，随访时间6 ～ 24 个月，平均13.6 个月。术后发生脱钩2 例、断钩1 例、锁骨应力性骨折1 例、异位骨化1 例、锁骨上皮神经损伤1 例、肩部出现异响不适3 例，均经再手术或对症处理治愈或好转。按洛杉矶加利福尼亚大学（UCLA）肩关节等级评分评定疗效，获优15 例，良27 例，可6 例，优良率87.5%。38 例于术后9 ～ 24 个月取出内固定物，未出现再骨折或肩锁关节再脱位情况。 结论 以锁骨钩钢板内固定治疗Neer Ⅱ型锁骨远端骨折和Tossy Ⅲ型肩锁关节脱位疗效良好，但需注意处理其并发症。

TREATMENT OF FRESH TOSSY TYPE III ACROMIOCLAVICULAR JOINT DISLOCATIONS AND NEER TYPE II DISTAL CLAVICLE FRACTURES WITH CLAVICULAR HOOK PLATE

Objective To investigate the cl inical efficacy, compl ications and necessity of removing internal fixation in treatment of fresh Tossy type III acromioclavicular joint dislocations and Neer type II distal clavicle fractures with clavicularhook plate. Methods From June 2005 to June 2008, 24 patients with fresh Tossy type III acromioclavicular joint dislocations and 20 patients with fresh Neer type II distal clavicle fractures were treated. There were 32 males and 12 females with an agerange of 18-66 years (38.5 years on average), involving 18 left shoulders and 26 right shoulders. The injury was caused bytraffic accident in 31 cases and by fall ing in 13 cases. The mean time from injury to operation was 4 days (range, 2-8 days). All patients were treated by reduction with clavicular hook plate fixation. The coracoclavicular l igaments were not sutured. The shoulder functions were evaluated according to University of Cal ifornia-Los Angeles (UCLA) score system and analysed before and after removing internal fixation. Results Wound infection occurred in 2 cases 1 week after operation and healed after symptomatic managment, the other incisions healed by first intention. One case accepted hook plate fixation again because of loosening hooking-up 1 week after operation. One case accepted hook plate removal and Kirschner wire fixation because of severe shoulder’s pain on the postoperative third day. Thirty-eight patients were followed up for 8-32 months (18 months on average), there was no plate breakage. Clavicle fractures got bony union after 3-6 months (4.2 months on average). At last followup (before plate removal), according to UCLA shoulder function score system, the results were excellent in 11 cases, good in 22 cases, and fair in 5 cases; the excellent and good rate was 86.8%. Because of shoulder’s pain, plates were removed in 20 patients 3-16 months (10 months on average) after operation. The cases were followed up 3-8 months (5 months on average) after removing plate. No dislocation and fracture occurred again. There was statistically significant difference (P lt; 0.01) in the functional scores of shoulder between before (30.55 ± 4.00) and after removing internal fixation (33.85 ± 1.95). Conclusion Clavicular hook plate fixation is an effective treatment for fresh Tossy type III acromioclavicular joint dislocations and Neer type II distal claviclefractures. Normative operating, correct plate moulding, functional rehabil itation after operation are key factors in preventingcompl ications and reaching good cl inical efficacy. For the patients with postoperative symptoms, the plate should be removed to improve the shoulder’s function.

带骨块喙肩韧带内移加锁骨钩钢板固定治疗 Tossy Ⅲ型肩锁关节脱位

目的  总结采用带肩峰骨块喙肩韧带内移加锁骨钩钢板固定治疗 Tossy Ⅲ型肩锁关节脱位的近期疗效。  方法  2003年6月－2008年3月，采用带肩峰骨块喙肩韧带内移重建喙锁韧带、肩锁关节锁骨钩钢板固定治疗35例Tossy Ⅲ型肩锁关节脱位。男24例，女11例；年龄17～58岁，平均32岁。车祸伤21例，摔伤10例，高处坠落伤4例。左侧 13 例，右侧 22 例。新鲜脱位 26 例，陈旧性脱位 9 例。受伤至手术时间 2 ～ 30 d，平均 9 d。  结果  术后切口Ⅰ期愈合 34 例，延期愈合 1 例。患者均获随访，随访时间 10 ～ 36 个月，平均 18 个月。术后钢板无松动、断裂，去除内固定后无肩锁关节再脱位、肩周肌肉萎缩及肩周炎发生。术后 10 个月肩关节功能参照 Lazzcano 标准评定：获优 31 例，良 4 例，优良率100%。   结论  采用带肩峰骨块喙肩韧带内移重建喙锁韧带、联合锁骨钩钢板固定治疗Tossy Ⅲ型肩锁关节脱位，手术操作简便，对肩部生理功能影响小，韧带重建可靠，内固定牢固，近期疗效满意。

锁骨钩钢板固定结合喙锁韧带重建治疗陈旧性肩锁关节脱位

目的 总结锁骨钩钢板固定结合喙锁韧带重建治疗陈旧性肩锁关节脱位的临床疗效。 方法 2003 年6 月－ 2008 年12 月，采用锁骨钩钢板固定结合喙锁韧带重建治疗17 例陈旧性肩锁关节脱位。男11 例，女6 例；年龄16 ～ 53 岁，平均39 岁。均为直接暴力致伤。左侧7 例，右侧10 例。Rockwood 分型：Ⅲ型14 例，Ⅳ型2 例，Ⅴ型1 例。受伤至手术时间为14 ～ 55 d，平均23 d。 结果 术后切口均Ⅰ期愈合。肩锁关节脱位均纠正，无神经、血管损伤等并发症发生。术后患者均获随访，随访时间6 ～ 15 个月，平均12 个月。术后3 ～ 6 个月取出锁骨钩钢板，无再脱位发生。术后6 个月按Karlsson 疗效评价标准：优12 例，良4 例，差1 例，优良率94.1%。 结论 锁骨钩钢板固定结合喙锁韧带重建具有操作简便、创伤小、固定可靠、可早期功能锻炼等优点，是治疗陈旧性肩锁关节脱位的一种有效方法。

REPAIR OF ACROMIOCLAVICULAR DISLOCATION WITH CLAVICULAR HOOK PLATE INTERNAL FIXATION AND CORACOACROMIAL LIGAMENT TRANSPOSITION

To explore the operative method and the cl inical outcomes of repairing acromioclavicular dislocation by clavicular hook plate internal fixation and coracoacromial l igament transposition. Methods From August 2004 to December 2007, 12 cases of acromioclavicular dislocation were repaired with the internal fixation of clavicular hook plate and the transposition of coracoacromial l igament. There were 9 males and 3 females aged 22-56 years old (average 32 yearsold). Causes of injury: 6 cases from fall ing injury, 4 cases from crush injury and 2 cases from traffic accident. There were 5 cases of the left acromioclavicular dislocation, and 7 cases of the right. According to acromioclavicular dislocation classification set by WANG Yicong, 8 cases were graded as type III, 3 cases as type IV, and 1 case as type V. The time from injury to operation was 3-28 days (average 6 days). The injured arm was hung after operation, and the function training was started 3-5 days after operation. Results All wounds healed by first intention, and the X-ray films showed complete reposition of acromioclavicular joints was achieved in all cases 1 week after operation. Over the follow-up period of 12-30 months, no plate and screw loosening, hook break and acromion fracture occurred. At 2 months after operation, 2 patients had sl ight pain when moving the shoulder, and the symptom disappeared when removing the plate. No re-dislocation was observed in all cases after removing the plate at 6-10 months after operation. The function of shoulder joint was assessed by Karlsson evaluation standard 1 year after operation, 11 cases were graded as excellent and 1 case was good. Conclusion For the repair of acromioclavicular dislocation, the method of combining clavicular hook plate internal fixation with coracoacromial l igament transposition has the advantages of minor wound, easy operation, l ittle influence on the function of shoulder joints, and rel iable restoration of the stabil ity of shoulder joint.

钩钢板治疗锁骨外侧端骨折伴肩锁关节脱位