对严重肩锁关节脱位手术治疗方法选择的探讨(附52例报告)

Discussion of surgery treatment of serious dislocation of acromio-clavicular joint

[目的]探讨Rockwood分级Ⅲ^。及以上的重度肩锁关节脱位的手术治疗方案，比较仅行锁骨钩板内固定和锁骨钩板内固定后再行喙锁韧带重建2种方法的疗效。[方法]回顾两种方法治疗的52例肩锁关节脱位，A组为内固定组共29人，男20例，女9例，平均年龄45岁，其中Rockwood分级Ⅲ度12人，Ⅵ度15人，V度2人。B组为内固定加喙锁韧带重建组共23人，男15例，女8例，平均年龄50．6岁，Rockwood分级Ⅲ度9人，Ⅵ度13人，V度1人。内固定方法均为AO锁骨钩板固定，重建喙锁韧带均采用改良Weaver法。随访8一12个月，以Lazzcaao标准进行评价，并以SPSS10．0统计软件计算，分级比较每级AB两组的手术疗效。[结果]手术疗效均较为满意，优良率均达到100％。两组之间仅优秀率有所不同，且Rockwood分级比较AB两组均未见显著性差异。[结论]锁骨钩板固定确实可靠，手术简单，创伤较小，是一种比较理想的内固定，在使用了可靠的锁骨钩板固定后，肩锁关节周围各结构的稳定性得到了重建，保证了肩锁关节的稳定愈合，同时可早期功能锻炼恢复。如无合并严重的三角肌和斜方肌的撕裂，可不需喙锁韧带重建。

[Objective]To explore the surgery protocol of the serious dislocation of acromio- clavieular joint, and compare the outcome of ORIF with AO/ASIF clavicle hook plate only to ORIF with eoraco -clavieular ligament reconstruction. [Method] Fity-two cases of the dislocation of acromio - clavicular joint were reviewed, Group A was ORIF only including 29 cases （ male 20, female 9, mean age 45）, according to the system of Rockwood, as Typelll in 12 patients ,TypelV in 15 patients and Type V in 2 patients, the other 23 cases ORIF with eoraeo-clavieular 1 ligament reconstruction was Group B （ male 15, female 8, mean age 50.6）, according to the system of Rockwood, as Typelll in 9 patients ,Typelg in 13 patients and TypeV in 1 patients, AO/ASIF claviadar hook plates were used for all of the ORIF, and modified Weaverg method was used to reconstruct eoraco-clavieular ligament. Outcome was evaluated by Lazzcano scale after 8-12 months, and data was analyzed by SPSS 10.0. [ Result] Good outcome was achieved in all of the patients, there was no significanty statistical difference between the two groups. Conclusion] Clavicle hook plate is a kind of perfect internal fixation. Reconstruction of eoraco -clavleular ligament is not neces- sary if the AO/ASIF plate is used, unless serious avulsion of deltoid and trapezius muscle involved.