锁骨钩钢板治疗TossyⅢ型肩锁关节脱位的疗效

Treatment of acromioclavicular dislocations with clavicular hook plates

目的探讨锁骨钩钢板治疗TossyⅢ型肩锁关节脱位的疗效及术中修补喙锁韧带和脱位愈合后取出钢板的必要性。方法自2002年3月～2006年1月使用AO／ASIF锁骨钩钢板治疗41例TossyⅢ型肩锁关节脱位患者，其中15例术中修补了喙锁韧带，18例在平均术后1年取出钢板。按照Constant＆Murley评分系统评定肩关节功能，并对喙锁韧带修补组和未修补组以及内固定取出前后进行对比分析。结果本组获得1年以上随访者共37例，随访时间12～45个月，平均27个月。术后1年所有随访患者肩关节总体评分平均为82．0分，喙锁韧带修补组（15例）评分平均为81．3分，喙锁韧带未修补组（22例）评分平均为82．5分，两组差异无统计学意义（t=1．097，P〉0．05）。内固定取出患者取出前、后肩关节评分平均分别为80．4分和90．5分，差异有统计学意义（t=3．79，P〈0．05）。结论AO／ASIF锁骨钩钢板是治疗TossyⅢ型肩锁关节脱位的一种有效方法。锁骨钩钢板治疗急性肩锁关节脱位可不必常规修复喙锁韧带，锁骨钩钢板长期留存于体内可能影响肩关节活动，有必要在脱位愈合后取出内固定。

Objective To investigate the treatment of acromioclavicular dislocations （Tossy type Ⅲ） with clavicular hook plates. Methods From March 2002 to January 2006, 41 patients with Tossy type Ⅲ acromioclavicular dislocation were treated with AO/ASIF clavicular hook plates. The coracoclavicular liga- ments were sutured in 15 cases, and the plates were removed 12 months postoperatively in 18 patients. The shoulder functions were assessed by Constant ＆ Murley functional assessment system, and compared between before and after removal of the plate, and between the groups with and without coracoclavicular ligament sutured. Results Thirty-seven patients were followed up from 12 to 45 months （average, 27 months）. Four were lost in follow-up one year after operation. After internal fixation, at the end of the first year follow-up, the mean score for all the patients was 82.0, for the suture group was 81.3, and for the non-suture group was 82.5. There was no statistically significant difference between the suture and non-suture groups （t=1.097, P〉0.05） . The mean functional scores of shoulder before and after removing the plates were 80.4 and 90. 5, respectively, with a significant difference （t=3.79, P〈0.05）. Conclusions AO/ASIF clavicular hook plating is an effective treatment for Tossy type Ⅲ acromioclavicular dislocation. It is not necessary to routinely suture the coracoclavicular ligament. We recommend that the plate should be removed after healing because it may limit the function of shoulder.