小切口Dewar手术治疗NeerⅡ型锁骨远端骨折.doc

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1、小切口Dewar手术治疗NeerⅡ型锁骨远端骨折作者：王军，崔青，刘晓慧，董占引，高印生，李景庆【摘要】［目的］探讨小切口Dewar手术治疗NeerⅡ型锁骨远端骨折的治疗方法和临床疗效。［方法］采用小切口Dewar手术治疗NeerⅡ型锁骨远端骨折共39例，术中不暴露肩锁关节和骨折端，将带联合肌腱的喙突骨块上移至锁骨，重建喙锁韧带，静力学固定和动力学复位骨折端。随访35例，随访时间：最短1年，最长18年，平均8.2年。［结果］采用Lazzcano疗效评定标准,优29例，良6例。X线片、CT平扫重建、MRI检查均显示骨折全部愈合，肩锁关节面光滑，无硬化，增生，囊性变等骨性关节炎的表现，关

2、节腔信号均匀。双肩中立位、负重位、持重位X线片，锁骨肩峰端关节面下缘与喙突的垂直距离D值比较结果，中立位患侧与健侧相比，P＞0.05无显著性差异；负重位与中立位相比，患侧和健侧均P＞0.05无显著性差异；说明前臂的重力作用及负重时肱二头肌与喙肱肌的收缩并不能使锁骨过度下移，骨折愈合后肩锁关节的稳定性良好。持重位与中立位相比，患侧和健侧D值均减小，P＜0.01。中立位与持重位之差值，患侧和健侧相比，P＞0.05，无显著性差异。表明肩锁关节稳定性与微动性均良好。上举位片均显示肩锁关节间隙良好，无撞击。［结论］小切口Dewar手术治疗锁骨远端不稳定性骨折效果良好，具有创伤小，手术操作过程简

3、单，内固定费用低廉的优点。【关键词】小切口；Dewar手术；锁骨远端骨折.［Method］ThirtyninecasesofNeerⅡdistalclavicularfractureweretreatedwithsmallincisionDewar'soperation.Theacromioclavicularjointandfracturesitewerenotexposed,andthecoracoidtipwithtendonweretransferredtotheclavicle.Thecoracoclavicularligamentswerereconstructed,an

4、dthedistalclavicularfracturecouldbestaticsfixedanddynamicsdiaplased.Thirty-fivecaseswerefollowedupfrom1to18years(averageof8.2years).［Result］AccordingtoLazzcano'sstandard,29caseshadexcellentand6caseshadgoodresults.Roentgenogram,CTandMRIshowedthatthefractureallhealedup,thesurfaceofacromioclavicul

5、arjointwasclean,andtherewasnoarthriticsignofcirrhosis，hyperplasiaandtheca.Thesignalofa-cjointwasuniformity.Theverticaldistance(D)fromthedistalclavicletothecoracoidintheroentgenogramofneutral,wristweightbearingandweightholduppositionwerecontrasted.Inneutralpositionradiograph,thedisastersidevsthe

6、healthysidehadsignificantdifference,P＞0.05;thebearingvsneutralposition,thedisastersideandthehealthysideallhadsignificant6difference,P＞0.05;theholdingvsneutralposition,thedisastersideandthehealthysideallhadsignificantdifference,P＜0.01;thedifferencebetweenneutralandholdingpositionofthedisastersid

7、evsthehealthysidehadsignificantdifference,P＞0.05.Thisshowedthatthecapabilityofstabilityofa-cjointweregood.TheRoentgenogramsofshoulderelevationpositionraiseshowedthattherewasnoimpactinthea-cjoint.［Conclusion］Theresultsofsmallincisi