肩关节镜下双纽扣钢板固定法与切开锁骨钩治疗RockwoodⅢ型肩锁关节脱位的对比研究

Endoscopic double button-plate fixation and cut clavicular hook in treatment of RockwoodⅢ acromioclavicular joint dislocation

目的对比肩关节镜下双纽扣钢板固定法与切开锁骨钩治疗RockwoodⅢ型肩锁关节脱位的临床疗效。方法选择乌鲁木齐市友谊医院骨一科2008年1月-2012年12月收治符合手术指征的34例RockwoodⅢ型肩锁关节脱位患者。其中采用肩关节镜下双纽扣钢板固定法14例(肩关节镜组),采用切开锁骨钩钢板治疗20例(锁骨钩钢板组)。比较两组手术时间、住院时间等基本情况,采用疼痛视觉模拟评分(VAS评分)、欧洲肩关节协会评分系统Constant评分和自我评分系统(SSV)评价两组患者术后1、3、6、12个月的肩关节功能。结果肩关节镜组手术时间、住院时间、恢复工作时间短于锁骨钩钢板组,术中出血量少于锁骨钩钢板组,差异有统计学意义(P<0.05)。肩关节镜组及锁骨钩钢板组治疗后肩关节Constant评分总分分别为(86.4±11.4)及(5.1±12.5)分,肩关节镜组Constant各项评分均高于锁骨钩钢板组,差异有统计学意义(P<0.05),两组治疗后SSV高于治疗前,VAS低于治疗前,肩关节镜组术后SSV高于锁骨钩钢板组,VAS低于锁骨钩钢板组,差异均有统计学意义(P<0.05)。两组并发症发生率差异无统计学意义(P>0.05)。肩关节镜组患者无异物感,锁骨钩钢板组有7例发生异物感,两组差异有统计学意义(P<0.05)。结论 2种方法治疗肩锁关节脱位均取得良好疗效,但肩关节镜双纽扣钢板固定法在手术创伤、手术时间、出血量、肩关节功能及疼痛等方面更具优势。

Objective To compare Endoscopic double button-plate fixation and cut clavicular hook in treat-ment of Rockwood Ⅲ acromioclavieular joint dislocation. Methods From January 2008 to December 2012, 34 Rockwood Ⅲ acromioclavicuiar joint dislocation patients were treated in line with the indications for surgery. The shoulder joint endoscopic double button plate fixation method which contained 14 cases （re-ferred to the arthroscopic shoulder group）, with open clavicular hook plate in 20 patients （clavicular hook plate group）. Compare time for operation and time in hospital. Evaluation the function of shoulder be-tween two groups of patients with VAS, SSV score and Constant scores. Results Time for operation, time in hospital and recovery time of arthroscopic shoulder group was shorter than the clavicular hook plate group, and there was less blood loss in the clavicular hook plate group, the difference has statistical signif-icance （P〈 0.05）. Shoulder joint Constant total score of the shoulder arthroscopy group, and the clavicu-lar hook plate group were （86.4±11.4） points and （5.1± 12.5） points, respectively. The arthroscopic groupsr Constant scores were higher than the clavicular hook plate group, there was statistical significance （P 〈0.05）, After treatment, SSV score was higher and VAS was lower than before, SSV score in shoul-der arthroscopy group was higher and VAS was lower than clavicular hook plate group, the differences has statistical significant （P 〈0.05）. Postoperative complications difference in the incidence has not gotten statistically significance （P 〉0.05）, the shoulder arthroscopy patients did not have foreign body sensa-tion. For Arthroscopic double-button plate fixation group, 7 cases have foreign body sensation. The two groups both have statistical significance （P 〈0.05）. Conclusion This study achieved good effect with two methods. Arthroscopie double-button plate fixation has the advantage in surgical trauma, time for opera-tion, blood loss, shoulder function and pain in Acromioclavicular joint dislocation.