摘要
背景:创伤性胸锁关节脱位是少见的骨科损伤,可造成临床漏诊及处理不当,其手术技术在不断进步,主要体现在内置物的改良。目的:探讨创伤性胸锁关节脱位的诊断及治疗研究的新进展,重点总结使用各种内置物手术治疗技术要点及优劣。方法:由第一作者应用计算机检索万方、知网中文数据库,检索词为"胸锁关节脱位;生物力学;内置物;内固定;肌腱重建;并发症;预后";同时检索PubMed英文数据库,检索词为"dislocation of sternoclavicular joint;biomechanics;implant;Internal fixation;tendon reconstruction;complications;prognosis"。检索时限为2010年7月至2020年2月。结果与结论:①创伤性胸锁关节脱位是容易漏诊并可能致命的创伤,利用CT及B超可确定诊断,MRI可显示纵隔结构损伤情况;②其手术治疗方式包括克氏针张力带内固定、钩钢板内固定、锁定钢板内固定、韧带加强与重建技术、关节置换等,克氏针及钢丝固定强度较差,并发症率较高,可应用于少年患者;跨关节钢板不符合微动关节的生物力学要求,难以实现牢固固定;钩钢板属于弹性固定的内置物,缺点在于尾钩结构造成骨质的磨损和刺激;韧带重建技术越来越受到重视,既可满足强度需要又符合生物力学特征。
BACKGROUND:Traumatic dislocation of sternoclavicular joint is a rare disease in orthopedics,which can cause misdiagnosis and improper treatment.Its operation technology is constantly improving,mainly because of the improvement of the internal objects.OBJECTIVE:To explore the new progress in the diagnosis and treatment of traumatic dislocation of sternoclavicular joint,and to summarize the key points and the advantages and disadvantages of operation with various implants.METHODS:The Chinese database of Wanfang and China National Knowledge Infrastructure was searched by the first author.The key words were“dislocation of sternoclavicular joint;biomechanics;implants;internal fixation;tendon reconstruction;complications;prognosis”.Simultaneously,the English database of PubMed was searched,with the search term of“dislocation of sternoclavicular joint;biomechanics;implant;internal fixation;tendon reconstruction;complications;prognosis”.The retrieval period was from July 2010 to February 2020.RESULTS AND CONCLUSION:(1)Traumatic dislocation of sternoclavicular joint is a kind of trauma which is easy to be missed and may be fatal.Computed tomograhy and B-ultrasound can be used to confirm the diagnosis.Magnetic resonance imaging can show the damage of mediastinum structure.(2)Surgical treatment methods include Kirschner wire tension band internal fixation,hook plate internal fixation,locking plate internal fixation,ligament strengthening and reconstruction technology,joint replacement and so on.The fixation strength of Kirschner wires and steel wires is unsatisfactory and its complication rate is high,but they can be used in juvenile patients.The cross joint steel plate does not meet the biomechanical requirements of the fretting joint,so it is difficult to achieve firm fixation.The hook steel plate belongs to the built-in object of elastic fixation,and the disadvantage lies in the abrasion and stimulation of the bone caused by the tail hook structure.More and more attention has been paid to ligament reconstruction technology,which not only meets the needs of strength,but also conforms to the characteristics of biomechanics.
作者
周继辉
李新志
周游
黄卫
陈文瑶
Zhou Jihui;Li Xinzhi;Zhou You;Huang Wei;Chen Wenyao(Department of Orthopedics,Renhe Hospital Affiliated to Three Gorges University,the Second Clinical Hospital of Three Gorges University,Yichang 443001,Hubei Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2021年第3期443-448,共6页
Chinese Journal of Tissue Engineering Research
关键词
骨
内固定
胸锁关节
脱位
生物力学
内置物
肌腱重建
综述
bone
internal fixation
sternoclavicular joint
dislocation
biomechanics
implant
tendon reconstruction
review
