两种内固定方法治疗AllmanⅢ度肩锁关节脱位的临床疗效比较

Comparison of therapeutic effects of two internal fixations for the treatment of acromioclavicular joint dislocation of Allman GradeⅢ

目的:比较克氏针张力带钢丝和锁骨钩钢板治疗AllmanⅢ度肩锁关节脱位的临床疗效。方法:1995年1月至2007年12月,应用两种方法治疗39例Ⅲ度肩锁关节脱位,平均随访时间均超过4年。其中克氏针张力带钢丝法(TBF)治疗18例,男12例,女6例;平均年龄(27.50±12.76)岁;取出内固定时间平均(4.28±1.27)个月。锁骨钩钢板法(CHP)治疗21例,男18例,女3例;平均年龄(34.76±12.39)岁;取出内固定时间平均(8.29±1.49)个月。依据内固定并发症、Karlsson评价方法、重新半脱位情况比较两种内固定的临床疗效。结果:TBF组患者受伤至取内固定时平均病程(4.28±1.27)个月,CHP组为(8.29±1.49)个月,两组比较t=-8.951,P<0.01,差异有统计学意义,即TBF组比CHP组病程短。TBF法和CHP法内固定并发症分别为5例和1例,两组比较,P=0.077>0.05,差异无统计学意义;发生重新半脱位分别3例和1例,两组比较,P=0.318>0.05,差异无统计学意义。Karlsson评价结果:TBF组A级15例,B级3例,C级0例;CHP组A级20例,B级1例,C级0例,两组比较,P=0.530>0.05,差异无统计学意义。结论:两种内固定方法均是治疗AllmanⅢ度肩锁关节脱位的有效方法,远期疗效满意。

Objective：To e.ompare therapeutic effects between Kirschner tension band fixation（TBF） and clavicular hook- plate （ CHP ） for treating acromioclavieular dislocations of Mlman Grade Ⅲ. Methods ： From Jan. 1995 to Dec.2007, a total of 39 patients who were diagnosed as acromioclavicular joint dislocation of Grade llI were treated with Kirschner tension band fixation（TBF 18 patients, 12 patients were male,6 patients were female ,mean age were （27.50±12.76） years old ,average fixation duration were （4.28± 1.27 ） months ） and clavicular hook plate fixation （CHP 21 patients, 18 patients were male, 3 patients were female, mean age were （34.76±12.39）years old, average fixation during were （8.29±1.49） months）. All the patients were followed up with a mean period over 4 years. The therapeutic effects of the two groups were compared base on complications, Karlsson scores and re-subluxation. Results：The average period from injury to fixation removal was （4.28±1.27） and （8.29± 1.49） months in TBF and CHP groups respectively, comparison between the two groups,t=-8.951, P〈0.01, there was statistical difference, and the course of disease in TBF group was shorter than that of CHP group. Five patients in TBF group and 1 patient in CHP group had complications （P=0.077〉0.05）, as well as 3 patients in TBF group and 1 patient in CHP group had re-subluxation （P=0.318〉0.05 ）. Karlsson evaluation results：in TBF group, 15 patients got a grade A result, 3 grade B and 0 grade C; and in CHP groups above data was 20,1 and 0 respectively （P=0.530〉0.05）. There was no statistical differences between the two groups in evaluation outcomes. Conclusion：The two fixation methods are all effective methods to treat Grade Ⅲ aeromin- clavicular dislocation of Grade Ⅲ, and the long-term outcome is satisfactory.