肩锁关节脱位治疗方法的选择与疗效分析

Selection of treatment methods and evaluation of therapeutic effects for acromioclavicular dislocation

目的:探讨4种不同方法治疗肩锁关节脱位的疗效.方法:本组146例,肩锁关节脱位按Allman分型:Ⅰ度脱位33例,Ⅱ度脱位67例,Ⅲ度脱位46例.采用4种方法治疗:保守治疗(Ⅰ度脱位33例,Ⅱ度脱位26例),闭合复位克氏针固定(Ⅱ度脱位32例),切开复位克氏针'8'字钢丝固定修复肩锁韧带及关节囊(Ⅱ度脱位9例,Ⅲ度脱位18例)、切开复位锁骨钩钢板固定修复肩锁韧带、关节囊、喙锁韧带及喙肩韧带移位(Ⅲ度脱位28例).以上分别为A、B、C及D组.结果:术后随访6～18个月(平均11.2个月),按Karlsson评分标准,A组优39例,良19例,差1例;B组优19例,良11例,差2例;C组优15例,良12例;D组优19例,良9例.除二例Ⅱ度脱位在电镜透视下闭合复位克氏针固定患者,克氏针外滑、脱位复发外,其余均无脱位复发、断针、感染等并发症.结论:术前正确判断肩锁关节脱位的类型,根据具体分型选择不同的治疗方法能获得较满意的疗效.

Objective-To discuss therapeutic effects of 4 different methods for the treatment of acromio- clavicular dislocation. Methods-According to Allman classification standard,33 patients of 146 were type Ⅰ , 67 type Ⅱ and 46 type Ⅲ. Four treatment methods were adopted. Thirty-three patients of type Ⅰ and 26 of type Ⅱ were treated with conservative methods（Group A）,32 of type Ⅱ treated with close reduction and Kirschner wire fixation（Group B）,9 of type Ⅱ and 18 of type Ⅲ treated with open reduction and Kirschner wire combined with steel wire fixation to repair acromioclavicular ligament and articular capsule（Group C） ,and 28 of type Ⅲ with open reduction and clavicle claw steel plate fixation to repair acromioclavicular ligament, articular capsule, coracoclavicuIar ligament and coracoacromial ligament （Group D）. Results：After 6 to 18 months follow-up（with an average of 11.2）, the therapeutic effects of all the patients were evaluated by the standard of Karlsson. In Group A,39 patients obtained excellent results, 19 good and 1 poor;in Group B, 19,11 and 2; Group C, 15,12 and 0;Group D, 19,9 and 0. Kirschner wire sliding and dislocation recurrencing were found in 2 patients who were type Ⅱ dislocation and treated with close reduction and Kirschner wire fixation. To other patients,operative complications such as dislocation recurrence, pin breaking and infection did not occur. Condusion：Accurate judgement of acromioclavicular dislocation type and adopting the corresponding treatment methods based on different injury type are helpful to obtain satisfactory clinical effects.