锁骨远端骨折伴肩锁关节脱位的治疗yq课件

绝对手术指证
1.开放或行将成为开放伤的骨折 2.锁骨远端骨折并喙锁韧带的完全撕裂损伤 2.进行性的神经、血管损伤 3.多发伤患者由于骨折而致的活动受限 4.痛性骨折不愈合
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
锁骨远端骨折伴肩锁关节脱位的 治疗
袁泉 徐州医科大学附属医院骨科
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
锁骨骨折分型 Allman 分型： I类 锁骨中段1/3的骨折，占72%~80%。 II类 锁骨外侧1/3的骨折，占10%~30%。 III类 锁骨内侧1/3的骨折，不足5%。
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
放射学检查
胸片前后位 30°/40°的头侧倾斜位 (包括内侧的胸锁关节和外侧的肩锁关节 ) 45°的头倾或尾倾位（Quesana位）:更易显示出骨折的移位情况 显示双侧锁骨的长片 :对比测量双侧锁骨的长度
早期已有的外科治疗操作技术方法—克氏针张力带
修复肩锁和喙锁韧带 肩锁韧带
喙肩韧带
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
早期已有的外科治疗操作技术方法—喙锁螺钉固定
Bosworth螺钉技术:放置困难，需二次手术取出，松动、断裂 Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
内容
锁骨远端解剖特点与诊断 骨折分类 内固定的挫折与反思 治疗方法的合理选择 锁骨远端骨折固定的发展
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
外科治疗的方法选择与利弊
克氏针张力带 喙锁螺钉 钢板螺钉 钩钢板螺钉 微创其它
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
早期已有的外科治疗操作技术方法—克氏针张力带
坚强固定
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
侧腋位Axillary Lateral View
The location of distal clavicle
Department of Orthopedics The Affilliated Hospital of Xuzhou 锁Me骨dic远al端University
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
物理检查
1. 神经血管进行的检查 臂丛的内侧束损伤：类似“尺神经损伤”的表现
2. 测量并对比双侧的脉搏 3. Biblioteka Baidu伤后生命体征变化评估系统（Advanced Trauma Life Support,
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
Neer II型骨折的治疗
Neer指出：尽管锁骨远端1/3的骨折并不常见，但其几 乎占了所有锁骨骨折不愈合的一半。
大多数肩关节外科医生建议对移位的锁骨远端II型骨折 行手术治疗
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
受伤机制
直接暴力: 上臂内收肩部上外侧着地致伤 间接暴力：FOOS受伤机制上臂外展；肱骨将暴力传达到肩峰
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
讨论（Discussion）
重建喙锁韧带？
锥状韧带：维持锁骨冠状位的稳定 斜方韧带：维持锁骨水平位的稳定
肩关节腋位片确定锁骨在水平位是否稳定－－斜方韧带是否完整 探查喙锁韧带－－重建韧带减少肩锁韧带负荷
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
ATLS）评估生命体征变化并进行相关的治疗，直到其他的损伤被明确 排除
Department of Orthopedics The Affilliated Hospital of Xuzhou Medical University
临床评估
1、肩部外伤史 2、局部高凸畸形 3、疼痛、肿胀、青紫 4、局限性压痛Point tenderness 5、 Cross arm adduction实验阳性