喙锁螺钉加张力带治疗肩锁关节脱位疗效分析

The analysis on the therapeutical effectiveness of coraco-clavicular screw and tension-band wire fixation in acromioclavicular dislocation

目的 探讨喙锁拉力螺钉加张力带固定术式对中青年和老年患者的疗效差异。方法 本组Tossy分类Ⅲ级肩锁关节脱位43例,其中男28例,女15例;年龄27～71岁,平均42岁。所有病例采用喙锁拉力螺钉结合张力带钢丝固定术治疗,分为中青年组(小于60岁)24例,老年组(大于60岁)19例,平均随访2.7年,两组结果进行比较,并分别与Phillips和Bragin的结果进行比较。结果 在疼痛与肌力方面,中青年组、老年组与Phillips的结果差异均无显著性意义。在畸形发生率上,中青年组结果优于Bragin的结果,差异有显著性意义(P<0.05)。老年组活动度与满意度两项的结果比中青年组及Phillips的结果差,均有显著性意义(P<0.05)。结论 中青年患者采用本手术方式能取得较好的效果,而老年患者并不适合该手术方式。

Objective To research the different results of old and middle-young patients after the operation of coraco-clavicular screw and tension-hand wire fixation in Tossy Grade Ⅲ acromioclavicular dislocation. Methods In this study, there were forty three patients with acromioclavicular dislocation, Tossy grade Ⅲ. All patients were adopted the therapies of coraco-clavicular screw and tension-band wire fixation in the acromioclavicular dislocation. There were twenty-eight men and fifteen women with an average age of 42 years. They were divided into two groups:the middle and young age(less than sixty) ,24 cases;and senile group(over sixty) , 19 cases. The results were compared with the statistical result of Phillips and Bragin. All the patients had been followed up on an average of 2.7 years. Results In the aspect of pain and myodemia, there was no significant difference between the results of young and middle group and that of Phillips;in the developmental rate of deformity, the pain:96% of the younger and 95% of the old were no or little pain. The range of movement: 92% of the younger and 69% of the old were normal or near normal. The power:96% of the young and 84% of the old were normal or near normal. The complications:Residual deformity of loss of reduction was present in 10% of the old and there is no deformity of loss of reduction was present in the young group. There were 4% unsatisfactory in younger and 26% unsatisfactory in the old. The movement and satisfaction of the old were worse,compared with that of Phillips' in younger(P<0.05). The young's incidence of deformity was lower,compared with the result of Bragin(P<0.05). Conclusion This kind of surgical operation is suitable for younger patients,but not suitable for the old patients with the same disease.