【摘要】  目的:探讨应用AO锁骨钩钢板(CHP)治疗锁骨远端骨折伴肩锁关节脱位的实用价值。方法:对1999年8月～2007年4月收治的锁骨远端骨折伴肩锁关节脱位28例，均采用AO锁骨钩钢板(CHP)内固定治疗，对其临床资料进行回顾性分析。结果:全部骨性愈合，随访8～48个月，平均23个月。无钢板断裂、螺钉松动、感染及再脱位，无骨折不愈合病例，肩关节功能均恢复良好。CHP取出时间8～17个月，平均11个月。结论:CHP对锁骨远端骨折并肩锁关节脱位治疗效果理想，骨折不愈合可以避免，并且可以早期功能练习，使骨折愈合与功能恢复同步进行，而且具有操作简单、易掌握、损伤小、疗效确切的特点，值得临床应用推广，是目前有效治疗此种损伤的最佳方法。

【关键词】  锁骨远端骨折伴肩锁关节脱位；锁骨钩钢板固定；治疗；应用研究

Treatment of fracture of the distal clavicle with dislocation of the acromioclavicular joint by the clavicular hook plate of the AO

    REN Jie, ZHANG Wei, ZHAO Hong-wei, et al (Department of Orthopaodics, Jilin Hospital of the Integration of Traditional and Western Medicin of Jilin Province, Jilin 132012, China)

    Abstract: Objective  To explore the practical value of the treatment of fractures of the distal clavicle with dislocation of the acromioclavicular joint fixed by clavicle hook plate of the AO (CHP). Method  A retrospective analysis of 28 cases of fracture of the distal clavicle with dislocation of the acromioclavicular joint in our hospital from Aug 1999 to Apr 2007 fixed by CHP were studied. Results  Follow-up lasted from 8 to 48 months (average of 23 months), all cases acquired fracture union. None of fracture ununited, infection, redislocation, screw loosen, plate broken were found. Functions of the shoulder joint were excellent. The CHP-removed time was 8 to 17 months, with an average of 11 months. Conclusion  The results that CHP fixed fracture of the distal clavicle with dislocation of the acromioclavicular joint are ideal. Fractures ununited is avoided. Early functional exercise promotes fracture healing with function recovered at the same tine. CHP is relatively simple with less injury, rapid postoperative recovery, convenient application, less operative, less complications and should be recommended extensively in clinicle application .Therefore, The CHP fixation is the best method of effective treatment of the trauma at present.

    Key Words: Fractures of the distal clavicle with dislocation of the acromioclavicular joint; Clavicle hook plate fixation;Treatment; Applicational study

    锁骨骨折是一种比较常见的骨折，约占骨折的6%左右。其中锁骨外1/3骨折即远端骨折占锁骨骨折的12%～15%，同时伴有肩锁关节脱位者较少见，而且骨折不愈合率高。对于合并肩锁关节脱位者，因属不稳定性损伤且局部复杂的生物力学致使其发生多方向移位，故应积极采取有效的方法，恢复肩锁关节及周围的正常肩部结构和功能［1］。自1999年8月～2007年4月，我科应用AO锁骨钩钢板（clavicle hook plate of the AO ，简称CHP）治疗锁骨远端骨折伴肩锁关节脱位28例，疗效满意，无骨折不愈合及再脱位。现分析报告如下。

    1  资料与方法 

    1.1  一般资料：本组28例，男17例，女11例；年龄20～58岁，平均34.6岁；左侧13例，右侧15例，均为闭合性损伤。所有病例均为单侧、新鲜骨折。其中交通事故伤17例，坠落伤8例，其他运动伤3例。X光片均显示锁骨远端骨折伴肩锁关节脱位。按Tossi(1963年)分类法将肩锁关节脱位分为3型：本组病例Ⅱ型10例,Ⅲ型18例。

    1.2  治疗方法：采用肌间沟麻醉，患者仰卧位，患肩后方垫高，头转向健侧。切口自肩峰沿锁骨至锁骨中远段，长8～10cm，显露锁骨中远端、肩锁关节及部分肩峰，清除骨折端及关节积血、关节软骨碎片。将脱位的肩锁关节复位后，用CHP的钩端钩入肩峰下，并外展肩关节使肩锁关节嵌合密切，然后将CHP的钢板部分压在锁骨近折段的上面,并继续向下压将锁骨远端骨折复位，对合达解剖复位，对锁骨皮质骨钻孔及攻丝后拧入长度适宜的螺丝钉，固定牢固后修补肩锁韧带。对远断端粉碎程度较重伴明显骨缺损者取自体松质骨植骨，对TossiⅢ型损伤于CHP上的侧孔拧入1枚螺丝钉，固定到喙突上增强稳定性，而且可使断裂的喙锁韧带对合。术中不修补喙锁韧带，减少了创伤，缩短了手术时间。术后用三角巾悬