分析带袢钢板内固定术后特有并发症的发生原因，总结相应预防对策。

回顾性分析自2011年9月至2020年7月113例接受带袢钢板内固定术的肩锁关节脱位及锁骨远端骨折患者临床资料，其中男42例、女71例；平均年龄（54.3±9.6）岁；Tossy Ⅲ型肩锁关节脱位76例、Cho Ⅱ型锁骨远端骨折37例；手术时间为伤后1~12 d，平均4.2 d。根据患肩正位片评估内植物位置及复位状态，采用Karlsson分级系统评估术后肩关节功能，观察记录手术并发症，闭环式分析并发症发生原因及相应预防措施。

113例术后获随访16个月至10年，平均39.1个月。锁骨远端骨折组中，术中定位导针穿透喙突基底时，发生1例臂丛神经一过性损伤。肩锁关节脱位组中，术中发现喙突骨折漏诊1例，手术中转为锁骨钩钢板内固定；术后第2天摄片发现另1例喙突骨折，知情同意后，予锁骨带外固定制动；发现1例患者锁骨上袢钢板滑脱至锁骨下，肩锁关节复位完全丢失，知情同意后，予非计划二次手术调整；发现7例肩锁关节复位部分丢失、予锁骨带外固定制动；术后4个月发现1例切口迟发感染，取出内植物并使用敏感抗生素后，伤口愈合；11例患者在术后1~7个月先后出现复位完全丢失。根据Karlsson分级标准，评估患者术后1年时的肩关节功能，肩锁关节脱位组Karlsson分级优55例、良13例、差8例（优良率89.5%）；锁骨远端骨折组Karlsson分级优29例、良5例、差3例（优良率91.9%）。

喙锁间带袢钢板技术虽然操作简易，但术中需注意的细节较多，选择合适的钻孔位置和钻孔方向至关重要。

Acromioclavicular instability is a frequent injury affecting young and athletic populations. Symptomatic, high-grade dislocations are suggested to be managed by various surgical procedures that utilize different grafts to achieve healing with a pain-free shoulder. Currently, the two modern techniques widely used are hook plate fixation and coracoclavicular ligament fixation using a suspensory loop device.

To investigate the causes and preventive strategies for specific complications after coracoclavicular suture button fixation.

A retrospective study was conducted to analyze the clinical data of 113 patients with acromioclavicular dislocations or distal clavicle fractures admitted to Changshu No.2 People's Hospital from September 2011 to July 2020. Seventy-six patients who suffered acromioclavicular dislocations were categorized as Tossy classification type Ⅲ, while 37 who suffered distal clavicle fractures were classified as Cho classification typeⅡ. There were 42 males and 71 females with an average age of (54.3±9.6) years (23 to 78 years ) . All patients were operated on after an average of 4.2 days from the initial injury. The anteroposterior radiographs of the affected shoulder were performed to evaluate the position of the implants and the reduction. The Karlsson degree system was used to assess the functional recovery of the affected shoulder. Specific complications related to the hardware or the surgical technique were recorded to explore the causes and related preventions.

The mean follow-up period was 39.1 months ( 16 to 120 months) . In the distal clavicle fracture group, one case suffered transient brachial plexus injury when a guide pin was drilled through the base of the coracoid process and recovered immediately with no dysfunction. In the acromioclavicular dislocation group, one case received unanticipated hook plate fixation as a coracoid process fracture was found during the procedure. Another coracoid process fracture and loss of reduction on radiographs were detected one day after the initial operation, and the patient received clavicular bandage immobilization for four weeks. One patient underwent revision surgery with informed consent as the button migrated inferior to the subclavian area, and the complete loss of reduction alignment was found on the immediate radiographs. Seven cases of subluxations on the radiographs were observed one day after the operation, which was attributable to the surgical procedure. The patients received clavicular bandage immobilization for four weeks. One delayed postoperative infection was diagnosed four months after the initial operation and treated with sensitive antibiotics and implant removal. Eleven cases of redislocations were identified during the 1 to 7 months follow-ups. By Karlsson degree system of 12 months after the operations, excellent results were obtained in 55 patients ( 72.4% ) and good in 13 patients ( 17.1%) in the acromioclavicular dislocation group. In contrast, excellent results were obtained in 29 patients (78.4%) and good in 5 patients (13.5% ) in the distal clavicle fracture group.

More attention should be paid to coracoclavicular suture button fixation even though it is maneuverable. It is crucial to create tunnels in the correct position and ideal direction.