关节镜辅助三小切口固定Neer II锁骨远端骨折△（开放获取）

Arthroscopy assisted fixation of Neer type II distal clavicular fracture through three small incisions (OA)

摘要:

[目的]介绍关节镜辅助 3 个小切口固定 Neer II 型锁骨远端骨折的手术技术和初步临床结果。[方法]对 53 例 Neer II 型锁骨远端骨折患者行上述手术治疗。患者全麻后采用沙滩椅位，先建立 D 入路为观察通道，检查喙突上表面。然后，关节镜移至 E 入路为观察通道，D 入路为操作通道，显露喙突下表面。装配肩锁关节定位手柄，定位喙突下表面中点。在距锁骨远端约 3.5 cm 处用硬膜外针定位锁骨前后缘，导钻装入定位手柄，于导钻套袖处沿锁骨取横行切口为 H 入路，将套袖顶至锁骨表面并钻取锁骨至喙突下表面中点的骨隧道。通过导引线环由下而上经喙突、锁骨骨隧道，将肩锁关节脱位固定系统引入，自锁骨上表面引出后收紧。撬拨骨折近端，纠正前后移位并以 2 枚直径 1.5 mm 克氏针经肩峰穿肩锁关节及锁骨远端骨折端固定至锁骨近端皮质。[结果]所有患者均顺利完成手术，术中均未发生神经损伤、骨折等并发症。牛津肩关节评分（oxford shoulder score, OSS） 由术前的 （52.1±2.3） 分显著降低至术后 1 年的 （13.7±1.9） 分 （P＜0.001），Constant-Murley 肩关节功能评分 （CMS）评分由术前的（28.5±5.7）分显著增加至术后 1 年的（92.9±2.3）分（P＜0.001）。术后 1 年影像检查显示骨折愈合。[结论] 采用关节镜辅助三小切口治疗 Neer II 型锁骨远端骨折的手术技术是可行的，且创伤小、固定牢靠、并发症少，初步临床疗效满意。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopyassisted fixation of Neer type II distal clavicular fracture through three small incisions. [Methods] A total of 53 patients underwent the abovementioned operation for Neer type II distal clavicle fracture. After general anesthesia, the patient was placed in a beach chair, and D portal was established as the observation channel to examine the upper surface of the coracoid process. Then, the arthroscope was moved to E portal for observation and D portal for operation, to reveal the lower surface of the coracoid process. Assemble the acromioclavicular joint guide handle to locate the midpoint of the lower surface of the coracoid process. An epidural needle was used to locate the anterior and posterior edges of the clavicle at a distance of about 3.5 cm from the distal end of the clavicle. The guide drill was installed with a positioning handle. A transverse incision was made along the clavicle at the sleeve of the guide drill as an H protal. The fixation system of acromioclavicular dislocation was introduced through the coracoid process and the clavicular tunnel from bottom to top through the guide wire loop, and then tightened from the upper surface of the clavicle. Prying the proximal fracture fragments to correct anteroposterior displacement, a Kirschner wire 1.5 mm in diameter was drilled passing acromion, acromioclavicular joint, proximal end and distal end of the clavicle to the cortical bone. [Results] All patients had operation performed successfully without complications, such as nerve injury and newly-occurred fracture during the operation. The Oxford Shoulder Score (OSS) significantly decreased from (52.1±2.3) before surgery to (13.7±1.9) 1 year after surgery (P＜0.001), whereas the Constant-Murley score (CMS) significantly increased from (28.5±5.7) before surgery to (92.9±2.3) one year after surgery (P＜ 0.001). All patients got fracture healed well 1 year postoperatively on imaging. [Conclusion] This arthroscopy-assisted fixation of Neer type II distal clavicular fracture through three small incisions is a feasible, and minimally invasive technique with high accuracy and less complications, achieves satisfactory primary clinical consequence.