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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.

Treatment on Carotid Artery Trauma

目的　总结颈动脉损伤患者救治的临床经验。 方法　2003年1月－2006年6月，抢救5例颈动脉损伤患者。男3例，女2例；年龄21～35岁。其中左右颈总动脉各1例，左锁骨下动脉2例，左椎动脉1例。合并损伤：左颈内静脉贯通伤1例，左胸导管及交感神经损伤1例，食道损伤1例，左锁骨骨折1例。受伤至入院时间20 min～3个月。受伤原因：刀刺伤3例，误食缝衣针伴感染1例，车祸伤1例。采用血管吻合修复颈总动脉及椎动脉3根、侧壁修补修复左锁骨下动脉1根、左颈内静脉1根及自体血管移植术修复左锁骨下动脉1根。术中输血量1 000～11 000 mL,平均3 800 mL。 结果　所有患者均抢救成功，伤口Ⅰ期愈合，经1～3年随访，无神经功能障碍。 结论　颈动脉损伤救治成功的关键在于尽早做出诊断，快速有效的急救及选择正确的治疗方法。

The Way to Choose the Method of Internal Fixation for Fracture of Midshaft of Clavicle

目的:探讨锁骨中段骨折最适内固定方式。方法:总结1990年1月～2007年6月426例锁骨中段骨折采用钢丝、克氏针、钢板内固定治疗，术后随访6个月～12个月，对不同内固定疗效进行评估。结果:钢丝固定53例，固定失败18例，优良率66.04%；克氏针固定97例，固定失败12例，优良率87.63%；钢板固定276例，固定失败19例，优良率93.12%。结论:钢丝固定锁骨中段骨折不确切，克氏针固定适应症窄，钢板内固定可靠，对抗上肢旋转剪力、内外张力，有利于骨折愈合和锁骨功能的早期建立。在应用的四种类型钢板中:解剖钢板、重建钢板术后并发症少，是治疗锁骨中段骨折较为理想的内固定方式。

Clavicular Midpiece Fracture Treated by Clavicular Blade Plate

目的:探讨锁骨接骨板这一技术在治疗锁骨中段骨折中的应用及其临床效果。方法: 通过系统回顾2005年5月至2008年6月我院收治的30例锁骨中段骨折患者，其中男性24例，女性6例；年龄范围从12岁到63岁，平均年龄为34岁，行手术时间为受伤后3～5天，经患侧刀砍形切口切开复位，予锁骨接骨板内固定，术后2周内予颈腕吊带悬吊，同时进行耸肩训练。术后2周后开始肩关节不持重功能锻炼。结果:30例患者手术均获成功，术后随访时间为4～12个月（平均随访时间6.5个月），所有患者局部无疼痛，行X线检查显示均为解剖骨性愈合，外观无畸形，18例患者一年后取出内固定，无再骨折发生，患者能接受切口线状疤痕，肩关节活动度:前屈平均155°，外展平均160°。结论:切开复位锁骨接骨板内固定锁骨中段骨折是一种较好的治疗方法，值得推荐。

巨大外穿性畸胎瘤致胸骨、锁骨畸形一例

Clinical Significance of Bilateral Supraclavicular Lymph Node Dissection for Intrathoracic Esophageal Carcinoma

Abstract： Objective To evaluate the clinical significance of bilateral supraclavicular lymph node dissection after esophagectomy for patients with intrathoracic esophageal carcinoma. Methods A total of 197 patients with esophageal carcinoma but no obvious supraclavicular lymph node metastasis who underwent esophagectomy in Zhongshan Hospital of Xiamen University from March 1997 to September 2004 were included in this study. All the patients were divided into 2 groups， the control group and the study group. In the control group (non-supraclavicular lymphadenectomy group)， there were 96 patients including 62 males and 34 females with their age of 40-69 （55.2±3.1） years， who received 2-field lymphadenectomy (intrathoracic lymphatic drainage area and left paracardial lymph nodes) without supraclavicular lymph node dissection. In the study group (supraclavicular lymphadenectomy group)， there were 101 patients including 68 males and 33 females with their age of 41-68 （53.8±4.5） years， who received 3-field lymphadenectomy including intrathoracic lymphatic drainage area， left paracardial lymph nodes and bilateral supraclavicular lymph node dissection. Postoperative survival rate， lymph node metastasis rate， anastomotic site recurrence rate， and long-term supraclavicular lymph node metastasis rate were compared between the 2 groups. Results The overall 5-year survival rate of all the patients was 39.59% （78/197）. There was no statistical difference in 5-year survival rate between the 2 groups ［37.50％ （36/96） vs. 41.58％（42/101）， P＞0.05］. However， the 5-year survival rate of the patients with esophageal carcinoma in the upper third of the esophagus in the study group was significantly higher than that of the control group ［38.10％（8/21） vs. 29.17％ （7/24）， P＜0.05］. The intrathoracic lymph node metastasis rate （14.58% vs. 12.87%）， abdominal lymph node metastasis rate （6.25% vs. 7.92%）and anastomotic site recurrence rate （5.20% vs. 5.94%）of the control group and study group were not statistically different （P＞0.05）. However， long-term supraclavicular lymph node metastasis rate of the study group was significantly lower than that of the control group （2.97％ vs. 8.33％， P＜0.05） Conclusion Bilateral supraclavicular node dissection can significantly increase postoperative survival rate and decrease long-term supraclavicular lymph node metastasis rate of patients with esophageal carcinoma in the upper third of the esophagus.

BRIDGING FIXATION WITH LONG LOCKING PLATE FOR DISPLACED MIDSHAFT CLAVICULAR FRACTURES

Objective To evaluate the effectiveness of bridging fixation with long locking plate for displaced midshaft clavicular fractures. Methods Between October 2010 and December 2011, 18 patients with displaced midshaft clavicular fracture were treated with reduction and bridging fixation with 9 or 10 holes locking plate. There were 17 males and 1 female with an average age of 47 years (range, 23-82 years). Fracture was caused by traffic accident in 6 cases, by falling in 10 cases, by crushing in 1 case, and by crashing object in 1 case. All fractures were closed and displaced or shortened (range, 2.1-3.4 cm; mean, 2.62 cm) with angulation deformity. According to Robinson classification criteria, 5 cases were rated as type 2B1 and 13 as type 2B2. The duration from injury to surgery was 5 hours to 19 days (mean, 5 days). The fracture healing time and complication were recorded; the effectiveness evaluation was performed with Constant-Murley score and satisfaction to appearance. Results No neurologic or vascular complication occurred with primary healing of incision. All patients were followed up 12-22 months (mean, 14.7 months). The fracture healing time was 9-14 weeks (mean, 11.4 weeks). During follow-up, no loosening or breakage of internal fixator was observed. The Constant-Murley score was 82-98 (mean, 92.4) at last follow-up; the satisfaction rate of appearance was 88.9% (16/18). Conclusion Bridging fixation with long locking plate is an effective method for treatment of displaced midshaft clavicular fractures. Preserved blood supply and stable angle are important to fracture healing.

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.

小切口切开复位Herbert 螺钉内固定治疗有移位的锁骨中段骨折

目的 总结采用小切口切开复位Herbert 螺钉内固定治疗有移位的锁骨中段骨折临床效果。 方法 2008 年5 月－ 2010 年3 月，采用微创小切口切开复位Herbert 螺钉内固定治疗32 例有移位的锁骨中段骨折。男21 例,女11 例；年龄16 ～ 75 岁，中位年龄32.3 岁。交通事故伤18 例，摔伤9 例，重物砸伤5 例。左侧14 例，右侧18 例。其中横形骨折6 例，斜形骨折8 例，粉碎性骨折18 例。患者伤后至手术时间为18 ～ 42 h，平均26.4 h。 结果 术后32 例均获随访，随访时间13 ～ 18 个月，平均14.6 个月。32 例均获解剖复位，无成角、短缩或分离移位，内固定物无移位。术后6 ～ 8 周骨折均达临床愈合，无畸形或延迟愈合、骨不连等并发症发生。术后肩关节功能根据Neer 评分标准均获优。 结论 小切口切开复位Herbert 螺钉内固定治疗有移位的锁骨中段骨折损伤小，促进了骨折愈合，可避免锁骨下动、静脉及臂丛神经损伤、气胸等并发症及二次手术。

锁骨钩钢板治疗胸锁关节前脱位八例

目的 总结锁骨钩钢板治疗胸锁关节前脱位的疗效。 方法 2003 年1 月－ 2008 年10 月，采用锁骨钩钢板治疗8 例交通事故伤所致胸锁关节前脱位。男7 例，女1 例；年龄30 ～ 54 岁。左侧2 例，右侧6 例。合并血气胸1 例，下肢骨折1 例，轻度脑外伤1 例。其中1 例脱位后曾行T 型钢板固定，术后15 d 内固定物松动，改为锁骨钩钢板固定；余7 例均为首次手术，受伤至手术时间为3 ～ 5 d。 结果 术后切口均Ⅰ期愈合，无神经、血管损伤及血气胸等并发症发生。8 例均获随访，随访时间6 ～ 15 个月，平均12.3 个月。随访期间X 线片示无内固定失败和再脱位发生。术后6 个月肩关节功能根据Rockwood 等的评分标准评分为12 ～ 14 分，平均13.6 分；其中优7 例，良1 例，优良率100%。 结论 利用锁骨钩钢板治疗胸锁关节前脱位是一种安全、有效的方法。