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find Keyword "锁骨远端骨折" 12 results
  • 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。

    Release date:2016-08-31 05:41 Export PDF Favorites Scan
  • 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.

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • Arthrex 纤维缝线固定治疗Neer Ⅱ型锁骨远端骨折

    目的 总结Arthrex 纤维缝线固定治疗Neer Ⅱ型锁骨远端骨折的疗效。 方法 2004 年1 月-2007 年12 月,采用单纯Arthrex 纤维缝线治疗31 例Neer Ⅱ型锁骨远端骨折患者。其中男21 例,女10 例;年龄15 ~ 64岁,平均34.6 岁。车祸伤17 例,跌伤11 例,坠落伤3 例。均为急性闭合性损伤。均有肩部皮肤挫伤,局部肿胀、疼痛,患侧上臂外展及上举功能受限。其中1 例合并同侧肋骨骨折。伤后至手术时间2 ~ 72 h,平均12 h。 结果 术后患者切口均Ⅰ期愈合。31 例均获随访,随访时间8 ~ 26 个月,平均13.7 个月。X 线片示所有患者骨折愈合良好,愈合时间为术后5 ~ 12 周,平均7 周。术后6 个月基本恢复至伤前活动能力。术后1 个月1 例局部残留疼痛,2 例肩关节功能部分受限,经对症治疗症状消失,功能恢复或基本恢复至伤前。采用美国肩关节功能评分表(ASES)评分为86 ~ 100 分,平均92.7分。 结 论 应用Arthrex 纤维缝线固定治疗Neer Ⅱ型锁骨远端骨折,手术方法简便实用、安全可靠。

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • CLINICAL EFFECTS OF CLAVICULAR HOOK PLATE FOR NEER TYPE Ⅱ FRACTURE OF DISTAL CLAVICLE

    Objective To analyze the clinical effect of clavicular hook plate in treating Neer type Ⅱ fracture of distal clavicle. Methods From March 2004 to April 2006, 15 patients suffering from Neer type Ⅱ fracture of distal clavicle were treated with clavicular hook plate, including 12 males and 3 females with an average age of 39 years (range,17-69 years). All patients had acute injury,including accident injury (8 cases) and falling injury (7 cases). The results were assessed by the JOA method. Results The wounds healed by first intention. No early complications were found. All patients were followed up for an average of 16.4 months(range,9-34 months) .The mean JOA score was 93.1. Themean pain parameter was 28.0, the fuction was 18.8 and the range of motionwas 26.3. The X-ray films showed that bony union was obtained in all patients after 3.6 months, and the mean healing period was 3.9 months.No acromioclavicular subluxation and dislocation occurred. Conclusion The principal advantages of this method are reliable fixation and early rehabilitation. It is necessary to protect rotator cuff and tissues behind acromioclavicular joint and remove the plate as soon as possible after bony union.

    Release date:2016-09-01 09:23 Export PDF Favorites Scan
  • 双Endobutton双环套锁内固定术治疗Tossy Ⅲ型肩锁关节脱位及Neer ⅡB型锁骨远端骨折

    目的总结双Endobutton双环套锁内固定术治疗TossyⅢ型肩锁关节脱位和NeerⅡB型锁骨远端骨折的疗效。 方法2010年4月-2013年4月采用双Endobutton双环套锁内固定术治疗17例Tossy Ⅲ型肩锁关节脱位和7例Neer ⅡB型锁骨远端骨折患者。男16例,女8例;年龄18~47岁,平均34岁。受伤至手术时间1~7 d,平均3.5 d。 结果术后患者切口均Ⅰ期愈合,无感染、臂丛神经及血管损伤等并发症发生。21例获随访,其中14例脱位患者随访时间12~20个月,7例骨折患者为12~24个月。锁骨远端骨折均获骨性愈合,愈合时间4~8个月,平均6个月。随访期间肩锁关节脱位无复发。术后12个月,Constant-Murley评分:脱位患者为(89.3±3.2)分,骨折患者为(87.2±2.6)分;按Karlsson标准评定:脱位患者获A级14例,B级3例;骨折患者获A级5例,B级2例。 结论双Endobutton双环套锁内固定术治疗Tossy Ⅲ型肩锁关节脱位和Neer ⅡB型锁骨远端骨折创伤小,手术操作简便,近期疗效满意。

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  • 自制过线器线缆微创内固定治疗Neer Ⅱ型锁骨远端骨折疗效观察

    目的介绍一种微创内固定方法治疗Neer Ⅱ型锁骨远端骨折,对其临床疗效进行评估。 方法2011年3月-2013年8月,采用一种自制过线器线缆微创内固定治疗15例Neer Ⅱ型锁骨远端骨折患者。男9例,女6例;年龄23~54岁,平均35岁。致伤原因:重物砸伤1例,交通事故伤14例。均为闭合损伤。伤后至手术时间26~42 h,平均32 h。 结果14例患者获随访,随访时间11~24个月,平均13个月。患者均未出现伤口感染、肩锁关节脱位、肩峰撞击、关节强直等并发症。X线片复查示骨折均获骨性愈合,愈合时间9~12个月,平均11个月;其中1例患者术后骨折轻度移位(移位约3 mm)。末次随访时肩关节功能采用Karlsson评分标准评价,获A级9例、B级5例。 结论自制过线器线缆微创内固定治疗Neer Ⅱ型锁骨远端骨折操作简便,学习曲线短,临床疗效较好。

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  • 解剖锁定板联合聚酯缝线固定治疗 Neer ⅡB 型锁骨远端骨折

    目的 总结解剖锁定板联合聚酯缝线固定治疗 NeerⅡB 型锁骨远端骨折的临床疗效。 方法 2013 年 8 月—2015 年 12 月,采用解剖锁定板联合聚酯缝线固定治疗 12 例 Neer ⅡB 型锁骨远端骨折患者。男 4 例,女 8 例;年龄 21~62 岁,平均 42.4 岁。致伤原因:交通事故伤 8 例,摔伤 3 例,高处坠落伤 1 例。受伤至手术时间 2~10 d,平均 4.5 d。X 线片测量患侧喙锁间距(coracoclavicular distance,CCD)为(12.4±3.5)mm。 结果 术后患者切口均 Ⅰ 期愈合,无手术相关并发症发生。12 例患者均获随访,随访时间 10~27 个月,平均 19.6 个月。X 线片复查示骨折均愈合,愈合时间 3~6 个月,平均 3.7 个月。术后 2 d 及末次随访时 CCD 分别为(8.9±1.3)、(9.3±1.3)mm,与术前比较差异有统计学意义(P<0.05);术后 2 d 及末次随访时比较,差异无统计学意义(P>0.05)。末次随访,患肩关节功能 Constant-Murley 评分为(94.8±6.9)分;优 9 例,良 2 例,可 1 例,优良率 91.7%。 结论 解剖锁定板联合聚酯缝线固定治疗 Neer ⅡB 型锁骨远端骨折疗效满意、并发症少,且手术操作相对简便、安全。

    Release date:2017-06-15 10:04 Export PDF Favorites Scan
  • Effectiveness of anatomical locking plate internal fixation combined with coracoclavicular ligament reconstruction for Neer typeⅡb distal clavicle fractures

    ObjectiveTo investigate the effectiveness of anatomical locking plate internal fixation combined with coracoclavicular ligament reconstruction in treatment of the Neer type Ⅱb distal clavicle fractures by comparing with the simple anatomical locking plate internal fixation.MethodsThe clinical data of 40 patients with Neer type Ⅱb distal clavicle fractures who met the criteria between February 2013 and January 2017 were analyzed. Eighteen cases were treated with anatomical locking plate internal fixation and coracoclavicular ligament reconstruction by using a suture anchor (reconstruction group), and 22 cases were treated only with anatomical locking plate internal fixation (non-reconstruction group). There was no significant difference in gender, age, injured side, causes of injury, associated injuries, time from injury to operation between 2 groups (P>0.05). The operation time, medical expense, postoperative coracoclavicular distance, Constant-Murley scores of injured side, and complications were recorded and compared between 2 groups.ResultsAll patients were followed up 12-27 months (mean, 16.3 months). One patient in reconstruction group had superficial wound infection. One patient in non-reconstruction group had pullout of screws from the distal fragment and reduction loss at 1 month postoperatively. The operation time and medical expense in reconstruction group significantly increased when compared with those in non-reconstruction group (P<0.05). All fractures in 2 groups achieved bony union at last follow-up. The rate of coracoclavicular distance increase of injured side in non-reconstruction group was significantly higher than that in reconstruction group (t=2.371, P=0.023). The Constant-Murley scores at 1 month, 3 months after operation, and last follow-up were significantly improved when compared with preoperative values in 2 groups (P<0.05), but no significant difference was observed between 2 groups (P>0.05).ConclusionBoth anatomical locking plate internal fixation with and without coracoclavicular ligament reconstruction can achieve good effectiveness for the Neer type Ⅱb distal clavicle fractures. Therefore, the coracoclavicular ligament reconstruction is not necessary, except for comminuted fractures with the length of lateral fragment less than 1 cm or the patients with poor compliance.

    Release date:2018-09-03 10:13 Export PDF Favorites Scan
  • Clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of unstable distal clavicle fractures

    ObjectiveTo evaluate the effectiveness of a clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of Neer types Ⅱ and Ⅴ distal clavicle fractures.MethodsBetween January 2010 and June 2016, 16 patients with Neer types Ⅱ and Ⅴ distal clavicle fractures were treated with clavicle hook plates and coracoclavicular ligament augmentation by suture anchor. There were 12 males and 4 females with an average age of 45.6 years (range, 14-81 years). The injury mechanism included falling in 10 cases, traffic accident injury in 2 cases, falling from height in 2 cases, and heavy object injury in 2 cases. The Neer classification of clavicle fractures included 2 cases of type Ⅱa, 13 cases of type Ⅱb, and 1 case of type Ⅴ. The injury severity score (ISS) was 6-29, with an average of 11.2. The time from injury to operation was 1-18 days, with an average of 6.4 days. The operation time, intraoperative blood loss, hospitalization stay, fracture healing, and postoperative complications were recorded; the disability of arm, shoulder, and hand (DASH) score, the shoulder joint Constant score, and the Oxford shoulder score (OSS) were used to evaluate the shoulder joint at last follow-up.ResultsAll operations were successfully completed. The operation time was 50-100 minutes, with an average of 75.6 minutes; intraoperative blood loss was 30-100 mL, with an average of 52.8 mL; hospitalization stay was 4-47 days, with an average of 13.7 days. All patients were followed up 1.2-7.5 years, with an average of 3.5 years. All clavicle fractures healed, and the healing time was 9.4-13.6 weeks, with an average of 11.9 weeks. No fracture nonunion, fracture displacement, failure of internal fixation, or incision infection, etc. occurred. Fifteen patients took out the hook plate after fracture healing and functional recovery, and 1 case refused to remove the hook plate from the second operation because of no obvious discomfort. At last follow-up, the DASH score was 0-13, with an average of 2.2; the shoulder joint Constant score was 90-100, with an average of 96.8; the OSS score was 12-14, with an average of 12.3.ConclusionClavicular hook plate with coracoclavicular ligament augmentation by suture anchor can help achieve good effectiveness with less postoperative complication in the treatment of Neer types Ⅱ and Ⅴ distal clavicular fractures.

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  • Effectiveness analysis of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicle fractures

    ObjectiveTo investigate the effectiveness of Endobutton plate coracoclavicular fixation combined with fracture site high-strength suture Nice knot cerclage fixation in the treatment of distal clavicle fracture with coracoclavicular ligament injury. Methods The clinical data of 33 cases of distal clavicular fracture with coracoclavicular ligament injury treated by Endobutton coracoclavicular plate fixation between January 2017 and December 2020 were analyzed retrospectively. According to the fixation methods of fracture site, they were divided into two groups: the high-strength suture Nice knot fixation group (study group, 16 cases) and the transacromial Kirschner wire fixation group (control group, 17 cases). There was no significant difference between the two groups in common data such as age, gender, injury side, cause of injury, Craig type, combined injury, time from injury to operation, and preoperative visual analogue scale (VAS) score and Constant-Murley score (P>0.05). Postoperative fracture healing and complications were observed, and the increase rate of coracoclavicular space on the affected side was calculated at last follow-up. VAS score was used to evaluate shoulder pain before operation, at 1 week, 1 month, 3 months after operation, and at last follow-up. The shoulder function was evaluated according to Constant-Murley shoulder score before operation, at 1 month, 3 months after operation, and at last follow-up. Results The operations were successfully completed in both groups without severe complications such as vascular nerve injury and coracoid fracture. In the control group, 1 case (5.9%) had slight pin tract infection and 1 case (5.9%) had Kirschner wire displacement; there was no obvious complication in the study group. The patients in both groups were followed up 9-36 months (mean, 22.9 months). The fracture healing time of the study group and the control group were (12.56±0.73) weeks and (13.59±0.87) weeks, respectively, and the difference was significant (t=−3.661, P=0.001). At last follow-up, the increase rates of coracoclavicular space on the affected side of the study group and the control group were 8.88%±1.19% and 8.55%±1.07%, respectively, showing no significant difference (t=0.837, P=0.409). The postoperative VAS score and Constant-Murley score of the two groups significantly improved when compared with those before operation, and the two scores gradually improved with the extension of time after operation (P<0.05). Except that the VAS score at 1 week and 1 month after operation and the Constant-Murley score at 1 month after operation in the study group were significantly better than those in the control group (P<0.05), there was no significant difference between the two groups at other time points after operation (P>0.05). Conclusion For oblique fracture or combined with butterfly fracture in the distal clavicle fracture with coracoclavicular ligament injury, the fracture site high-strength suture Nice knot fixation is a good supplement to the Endobutton plate coracoclavicular fixation. It can stabilize the fracture end, reduce the complications of Kirschner wire fixation, and is more conducive to fracture healing. The effectiveness is satisfactory.

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