[转载]肩锁关节脱位的手术治疗及护理

2009-04-13 文章来源:admin 点击量:1019   我要说

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【摘要】&nbsp 目的 评估锁骨钩钢板异体肌腱移植重建喙锁韧带的手术疗效及总结护理经验。方法 17例肩锁关节脱位患者采用锁骨钩钢板固定,同时利用新鲜冰冻异体肌腱移植重建喙锁韧带术前进行护理评估针对患者特点做好心理护理和准备工作消除患者的恐惧紧张心理使患者主动配合手术治疗。术后予有效护理及康复治疗并随访评估疗效。结果 依据Karlsson标准评定疗效,优良率为93。术后早期恢复肩关节功能,远期疗效佳,并发症少。结论 此种手术方式有效提供了早期机械稳定性及晚期生物学稳定疗效确切。做好围术期护理对于防止并发症、促进患肢功能恢复有重要意义。
【关键词】&nbsp 肩锁关节脱位;内固定;喙锁韧带重建;护理
&nbsp&nbsp&nbsp&nbsp&nbsp Operative treatment and nursing of acromioclavicular dislocation
&nbsp&nbsp&nbsp&nbsp [Abstract]&nbsp Objective&nbsp To evaluate the clinical effects of clavicular hook plate allogentic tendon grafts and summarize nurse experience in the treatment of acromioclavicular dislocations.Methods&nbsp Seventeen cases of severe acromioclavicular dislocation received open reduction and clavicular hook plate fixationthe coracoclavicular ligaments were reconstructed by freeze allogentic tendonsand physiological state was evaluated before operationso as to eliminate dread mentation psychology and match the treatment.Efficient nurse and rehabilitation was given after operation.Results&nbsp The good and excellent rate was 93 according to Karlsson evaluated standard.The shoulder function recovered earlyand the late effects were goodwith less complication.Conclusion&nbsp Such operation method produces sufficient mechanic stability and biological stability in the early and late postoperation stage respectively.Perioperation nurse is important to prevent complication and improve&nbsp the injury limb’s function recovery.
&nbsp&nbsp&nbsp [Key words]&nbsp acromioclavicular dislocation internal fixation coracoclavicular ligament reconstructionnurse
&nbsp&nbsp&nbsp 锁骨钩钢板已广泛应用于重度肩锁关节脱位的治疗具有疗效确切、术后早期可恢复关节功能等优点但也在一定程度上影响了骨科医生对恢复喙锁韧带结构完整性的重视手术操作上常常因为喙锁韧带较短难以寻找韧带修复相当困难流于形式,以致内固定钢板取出后肩锁关节脱位复发。鉴于此,我们在锁骨钩钢板固定的基础上行异体肌腱移植重建喙锁韧带,最终达到肩锁关节的生物稳定。2002~2005年我科开展此类手术17例并进行随访。结果显示远期疗效佳,现总结报告如下。
&nbsp&nbsp&nbsp 1&nbsp 资料与方法
&nbsp&nbsp&nbsp 1.1&nbsp 一般资料&nbsp 本组急性肩锁关节脱位依据Tossi分类均为3型共计17例男12例女5例年龄17~52岁平均30岁左侧11例右侧6例均为单侧。伤因:车祸伤11例重物砸伤2例高处坠落伤2例运动伤1例打击伤1例。受伤距手术时间7 h~14天。合并伤:颅脑损伤2例同侧肘关节骨折1例。
&nbsp&nbsp&nbsp 1.2&nbsp 手术方法&nbsp 患者取仰卧位,臂丛神经麻醉,患肩垫高,切口于锁骨中外1/3处远端向肩峰延伸,近端向内下方,切开深筋膜探查肩锁关节、斜方肌、喙锁韧带等损伤情况,清理肩锁关节间破裂的半月板组织及血肿,暴露锁骨远端的3 cm骨质,向下分离暴露喙突,复位肩锁关节,将钩插至肩峰后下方,安装钢板并临时固定于锁骨,注意确保完全复位,必要时用C型臂透视证实。如复位不全可将钩弯度加大以调整复位。注意不可过度剥离附着于锁骨的软组织,固定完成后修复缝合关节囊及肩锁韧带,将新鲜冰冻异体肌腱折叠成双股,一端逢于喙突,另一端固定于锁骨,操作中注意保护锁骨下血管神经,最后修复三角肌、斜方肌筋膜,张力下缝合深筋膜。
&nbsp&nbsp&nbsp 1.3&nbsp 护理措施
&nbsp&nbsp&nbsp 1.3.1&nbsp 心理护理&nbsp 消除患者对治疗的顾虑,耐心讲明此种手术的优良效果及预后,让患者树立信心,积极配合治疗。
&nbsp&nbsp&nbsp 1.3.2&nbsp 专科护理&nbsp 伤员对肩部的疼痛比较敏感要注意止痛术前及术后予妥善悬吊固定患肢适当应用镇痛剂术后严密观察患肢感觉及运动变化情况,保持伤口干燥。如有渗血、渗液,应给予擦拭或换
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