喙锁韧带重建联合钩钢板固定或缝合锚固定治疗肩锁关节脱位的对比研究

Comparative study on the treatment of acromioclavicular joint dislocation： coracoclavicular ligamentreconstruction combined with hook plate fixation or suture-anchor fixation

目的探讨采用喙锁韧带重建联合钩钢板固定或缝合锚固定治疗肩锁关节脱位的疗效。方法自2007年2月至2010年4月，将RockwoodⅢ型以上肩锁关节脱位并符合纳入排除标准的105例患者随机分为钩钢板固定组（54例）和缝合锚固定组（51例），分别应用双股掌长肌腱重建喙锁韧带联合钩钢板或缝合锚固定治疗。定期随访患者，在X线片上测量肩锁间距和喙锁间距，末次随访应用Karlsson评分和Constant—Murley评分评估手术疗效。等级资料应用X^2检验、计量资料应用两样本t检验分析。结果16例患者失访，89例患者获得随访，随访时间24～42个月，平均30个月。其中钩钢板固定组46例，缝合锚固定组43例，两组患者在年龄、性别、损伤侧别、受伤至手术时间和Rockwood分型方面具有可比性。两组肩锁间距和喙锁间距比较，术后6个月内差异无统计学意义（P〉0．05），术后24个月钩钢板固定组明显大于缝合锚固定组（F=1．904和1．854，P〈0．05）；钩钢板固定组术后24个月肩锁间距和喙锁间距均大于其6个月测量数据（F=1．863和1．842，P〈0．05）。末次随访Constant—Murley评分钩钢板固定组平均88．5分低于缝合锚固定组的平均92．7分（F=0．475，P=0．017）。Karlsson评分缝合锚固定组患者功能优良率为95．4％，明显优于钩钢板固定组的80．5％（X^2=4．564，P=0．033）。结论喙锁韧带重建结合缝合锚固定治疗肩锁关节脱位患者疗效优于喙锁韧带重建结合钩钢板固定。钩钢板固定取出后，肩锁间距和喙锁间距显著增加，可能与其疗效较差有关。

Objective To investigate the clinical outcomes of acromioclavicula （AC） joint dislocation treated with coracoclavicular （CC） ligament reconstruction and hook plate fixation/suture-anchor fixation. Methods There were 105 patients with Rockwood typeⅢ or severer AC joint dislocations were randomly divided into two groups from February 2007 to April 2010. They were treated with CC ligament reconstruction using double bundle of Palmaris l]ongus （hook plate fixation group, 54 cases ）, and subsequently fixed with hook plates or suture-anchors （suture-anchors group, 51 cases）. Patients were followed up, and the AC distance and CC distance were measured on the postoperative X-ray films, and the outcomes were assessed according to Karlsson criteria and Constant-Murley shoulder score. Ranked data was analyzed with the use of X2 test and measurement data with two sample t test. Results Eighty-nine patients were followed up for 24-42 months ,average 30 months. There were 46 cases in hook plate fixation group and 43 cases in suture-anchor fixation group, without significant difference in age, gender, injured side and Rockwood classification between both groups. Between the two groups, no statistical difference was detected in the AC and CC distance measured within 6 months after operation （P 〉 0. 05 ）. The AC and CC distances of hook plate fixation group measured in 24 months postoperatively were larger than those in suture-anchor fixation group, respectively （ F = 1. 904 and 1. 854, P 〈 0. 05 ）. In hook plate fixation group, the AC and CC distances measured in 24 months postoperatively were larger than those measured in 6 month postoperatively, respectively（F = 1. 863 and 1. 842, P 〈 0. 05）. According to Constant-Murley shoulderscore, the average score was 88.5 for hook plate fixation group and 92.7 for suture-anchor fixation group （F=0. 475,P = 0. 017）. According to Karlsson criteria, the excellent and good rate of the functional recovery was 95.4% in suture-anchor fixation group, better than hook plate fixation group （X2 = 4. 564,P = 0. 033 ）. Conclusions The clinical outcomes of AC joint dislocation treated with CC ligament reconstruction and suture-anchor fixation are better than those treated with CC ligament reconstruction and hook plate fixation. The AC and CC distances increase after the removal of hook plate, which may be associated with poor functional recovery.