TightRope钢板与锁骨钩钢板治疗Rockwood Ⅲ型急性肩锁关节脱位的疗效比较分析

Comparative analysis of the efficacy of TightRope plate versus clavicular hook plate in the treatment of acute Rockwood typeⅢ acromioclavicular joint dislocation

目的比较TightRope钢板与锁骨钩钢板治疗Rockwood III型急性肩锁关节脱位的预后疗效。方法选择2016年1月至2020年3月上海市宝山区罗店医院收治的急性肩锁关节脱位患者60例,根据手术选择的内固定类型分为TightRope钢板组(n=24)和锁骨钩钢板组(n=36)。观察比较两组患者手术相关指标的变化,包括手术时间、切口长度、术中失血量、住院时间、恢复正常工作时间。比较两组患者术前和术后的视觉模拟评分(visual analogue score,VAS)和肩关节Constant-Murley评分的变化情况。选择Karlsson标准评估患者术后临床预后疗效。比较两组患者术后并发症的发生情况。结果TightRope钢板组手术时间长于锁骨钩钢板组(P<0.05)。TightRope钢板组与锁骨钩钢板组相比,手术切口长度小、术中失血量少、住院时间短、恢复工作时间短(P<0.05)。手术前两组患者的VAS评分、Constant-Murely评分比较差异无统计学意义(P>0.05)。手术后第1天、6个月、12个月两组患者的VAS评分均较手术前明显下降,并且TightRope钢板组VAS评分明显低于锁骨钩钢板组(P<0.05)。手术后6个月、12个月两组患者的Constant-Murely评分较术前明显升高,并且TightRope钢板组的Constant-Murely评分高于锁骨钩钢板组,差异有统计学意义(P<0.05)。根据Karlsson标准评估,TightRope钢板组优良率为91.7%,锁骨钩钢板组为86.1%。锁骨钩钢板组的并发症发生率为16.7%,高于TightRope钢板组的8.3%。结论TightRope钢板和锁骨钩钢板治疗Rockwood III型急性肩锁关节脱位患者术后肩关节功能均可得到有效恢复。锁骨钩钢板组手术时间短,而TightRope钢板组手术切口小、住院时间短、术中出血量少、术后并发症和疼痛评分均较低,并且无需二次手术取出内固定,更早返回工作岗位。

Background With the change and diversification of life,sports,and transportation methods,acromioclavicular joint dislocation is increasing yearly,accounting for about 9%of shoulder injuries.Dislocations of the acromioclavicular joint have been associated with damage to the acromioclavicular capsule,the acromioclavicular ligament,and the coracoclavicular ligament.It manifests as"step-like"displacement of the distal clavicle,shoulder pain,limited abduction,lifting activities,and decreased muscle strength.The Rockwood classification is divided into six types according to the degree of ligament damage and imaging findings.Among them,type I and type II choose conservative treatment,type IV-VI choose surgical treatment,and typeⅢis still controversial.Studies have found that acromioclavicular joint dislocation typeⅢand above are often accompanied by instability of the acromioclavicular joint,affecting the shoulder joint's movement function.Reconstruction of the coracoclavicular ligament and restoration of stability of the acromioclavicular joint contribute to the recovery of shoulder motion,improved quality of life,and early return to work.Currently,common surgical methods for acromioclavicular joint dislocation include clavicle hook plate,Kirschner wire tension band,TightRope plate,acromioclavicular and coracoclavicular ligament reconstruction,etc.A clavicle hook plate is currently the most commonly used method for the dislocation of the acromioclavicular joint,which can provide a rigid internal fixation effect.Still,there are many postoperative complications,such as limited shoulder joint movement,pain,acromial dissolution,subacromial impingement,secondary Surgical removal of internal fixation,etc.TightRope plate is a new technology with less trauma,fewer postoperative complications,a good prognosis,and no need for secondary surgery to remove internal fixation.There are few clinical analyses on the prognosis and efficacy of TightRope plate and clavicle hook plate in the treatment of Rockwood typeⅢacute acromioclavicular joint dislocation.Objective To compare the efficacy of TightRope plate versus clavicular hook plate in treating acute Rockwood typeⅢacromioclavicular joint dislocation.Methods From January 2016 to March 2020,60 patients with acute Rockwood type III acromioclavicular joint dislocation were admitted to our hospital.According to the types of plate utilized in the surgery,the patients were selected and divided into two groups,the TightRope plate group(n=24)and the clavicular hook plate group(n=36).The characteristic of surgery with two groups was collected and compared,including the operation time,the incision length,intraoperative bleeding volume,postoperative hospitalization time,and recovery time.Before and after the operation,the pain in the shoulder joint was assessed by a visual analogue scale(VAS),and the function of the shoulder joint was evaluated by Constant-Murley scores.Karlsson's criteria evaluated the clinical effect of patients twelve months after the operation.The incidence rates of postoperative complications were also collected.Results The operation time in the TightRope plate group was longer than that in the clavicular hook plate group(P<0.05).The incision length was shorter than the clavicular hook plate group,and intraoperative bleeding volume was lesser.The postoperative hospitalization and recovery time were faster in the TightRope plate group(P<0.05).There was no significant difference in VAS scores and Constant-Murley scores between the two groups before the operation(P>0.05).The VAS scores of the patients in the two groups on the first day,six months,and twelve months after the operation were significantly lower than that before the operation,and the VAS score of the TightRope plate group was lower(P<0.05).The Constant-Murley score in the two groups at six months and twelve months after the operation was significantly higher than before,and the Constant-Murley score of the TightRope plate group was higher(P<0.05).The fineness rate in the TightRope plate and clavicular hook plate groups was 91.7%and 86.1%,respectively.The incidence of postoperative complications in the clavicular hook plate group was 16.7%,and in the TightRope plate group was 8.3%.Conclusion TightRope plate and clavicular hook plate can effectively restore shoulder function in patients with acute Rockwood type III acromioclavicular joint dislocation.The clavicular hook plate had a short operative time.The TightRope plate had a shorter incision length,lower intraoperative bleeding volume,shorter postoperative hospitalization time,lower postoperative VAS score,and a lower complication rate.Furthermore,the TightRope plate group without need secondary surgery to remove the internal fixation and return to work earlier.