Ⅲ型肩锁关节脱位的疗效评价

THE EVALUATION OF THE TREATMENT RESULTS OF TYPE Ⅲ ACROMIOCLAVICULAR DISLOCATION

为给临床治疗Ⅲ型肩锁关节脱位选择方法提供依据。对１９８５ ～１９９８ 年分别采用手法整复“８”字外固定（ Ａ 组） 、经皮克氏针内固定（Ｂ 组） 、喙锁韧带修复肩锁间固定（Ｃ 组） 等９ 种方法，收治的２４６ 例该病患者的临床资料进行了回顾性分析。依据外观、疼痛、功能范围、Ｘ 线片４ 项指标制订了Ⅰ～Ⅵ级疗效评定标准，逐一病例进行统计、归纳。结果达Ⅰ、Ⅱ级优等率者，Ａ 组中≤１２ 岁者为８２ ．４ ％ ，＞ １２ 岁者为３８ ．７ ％ ；Ｂ 组为４１ ．７ ％ ；Ｃ 组为７８ ．６ ％ ；Ｄ 组为８３ ．３ ％ ；Ｅ 组为６３ ．１ ％ ；Ｆ 组为６６ ．７ ％ ；Ｇ 组为６１ ．１ ％ ；Ｈ 组为２１ ．７ ％ ；Ｉ 组为６４ ．９ ％ 。认为对≤１２ 岁的新鲜肩锁关节脱位应以保守治疗为主；手术修复喙锁韧带行肩锁间固定法优于修复肩锁韧带行喙锁间固定；锁骨远端切除术易遗留前后不稳。

In order to provide a basis for selecting the therapeutic method for type Ⅲ acromioclavicular dislocation, the clinical data of 210 cases admitted and treated by the authors from January 1985 to January 1998 were retrospectively analysed. All the patients were divided into 9 groups (from Group A to Group I), which were treated by 9 different methods, respectively. The therapeutic effect of each case was evaluated by six grades (Ⅰ-Ⅵ) and four indices, such as the appearance, pains, functional range and X rays. The results showed that the percentages of the patients  12 years obtaining the excellent (Ⅰ or Ⅱ grade) rate of all the groups were: 82.4 % of Group A, 41.7 % of Group B, 78.6 % of Group C, 83.3 % of Group D, 63.1 % of Group E, 66.7 % of Group F, 61.1 % of Group G, 21.7 % of Group H, and 64.9 % of Group I, suggesting that the fresh patients  12 years should be treated mainly by the conservative method. In surgical treatment, the coracoclavicular ligament repair and the acromioclavicular arthrodesis have an advantage over the acromioclavicular ligament repair and coracoclavicular arthrodesis, and the distal clavicle removal has the anteroposterior unstability as the sequela.