锁骨钩钢板联合斜方肌筋膜瓣重建肩锁韧带及喙锁韧带治疗肩锁关节脱位

EFFECTIVENESS OF CLAVICULAR HOOK PLATE COMBINED WITH TRAPEZIUS MUSCLE FASCIA FOR RECONSTRUCTION OF ACROMIOCLAVICULAR AND CORACOCLAVICULAR LIGAMENTS TO TREAT COMPLETE ACROMIOCLAVICULAR JOINT DISLOCATION

目的通过与单纯锁骨钩钢板固定比较,探讨锁骨钩钢板固定联合斜方肌筋膜瓣重建肩锁、喙锁韧带治疗肩锁关节脱位的疗效。方法 2008年1月-2012年4月,收治66例肩锁关节脱位患者。其中32例采用锁骨钩钢板固定联合斜方肌筋膜瓣重建肩锁、喙锁韧带治疗（试验组）,34例仅采用锁骨钩钢板固定治疗（对照组）。两组患者性别、年龄、损伤侧别、致伤原因及受伤至手术时间等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。术前及术后2年测量两组患者疼痛视觉模拟评分（VAS）和肩关节Constant评分;摄肩关节正位X线片,测量喙突上平面与锁骨下平面的垂直距离（coracoid clavi-cledistance,CC.Dist）;术后2年行MRI定量分析韧带噪声比（signal/noise quotiem,SNQ）;记录术后并发症发生情况。结果两组患者术后切口均Ⅰ期愈合。试验组并发症发病率为12.5%（4/32）,显著低于对照组的91.2%（31/34）（χ^2=40.96,P=0.00）。患者均获随访,随访时间2-4年,平均2.8年。术后2年两组VAS评分及CC.Dist均较术前明显降低（P〈0.05）,且试验组显著低于对照组（P〈0.05）。术后2年,试验组患侧肩关节Constant评分获优19例,良11例,一般2例,优良率为93.75%;对照组获优7例,良8例,一般16例,差3例,优良率为44.11%。术后2年试验组患侧肩关节Constant评分显著高于对照组,比较差异有统计学意义（t=2.30,P=0.03）。术后2年试验组SNQ显著低于对照组（t=55.03,P=0.00）,提示试验组韧带愈合更好。结论与单纯锁骨钩钢板固定相比,联合斜方肌筋膜瓣重建肩锁、喙锁韧带治疗肩锁关节脱位,术后韧带愈合可靠,可减少并发症发生,早期肩关节功能改善明显。

Objective To explore the effectiveness of the clavicular hook plate combined with trapezius muscle fascia for reconstruction of acromioclavicular and coracoclavicular ligaments to treat acute complete acromioclavicular dislocations. Methods Between January 2008 and April 2012, 66 patients with acromioclavicular dislocation were treated with the clavicular hook plate combined with trapezius muscle fascia for reconstruction of acromioclavicular and coracoclavicular ligaments in 32 cases（experimental group） and with the clavicular hook plate in 34 cases（control group）. There was no significant difference in gender, age, injured side, the cause of injury, and the time from injury to operation between 2 groups（P〉0.05）. Visual analogue scale（VAS）, Constant shoulder scores, and coracoid clavi-cledistance（CC.Dist） were measured at preoperation and at 2 years after operation. Signal/noise quotiem（SNQ） was measured by MRI at 2 years after operation. The operation complications were observed. Results The patients of 2 groups obtained primary healing of incision. The morbidity of complication in experimental group（12.5%, 4/32） was significantly lower than that in control group（91.2%, 31/34）（χ^2=40.96, P=0.00）. All the cases were followed up 2.8 years on average（range, 2 to 4 years）. VAS scores and CC.Dist significantly decreased at 2 years after operation when compared with preoperative values in the 2 groups（P〈0.05）. VAS scores and CC.Dist of the experimental group were significantly lower than those in the control group（P〈0.05）. According to Constant shoulder scores at 2 years after operation, the results were excellent in 19 cases, good in 11 cases, and general in 2 cases with an excellent and good rate of 93.75% in the experimental group; the results were excellent in 7 cases, good in 8 cases, general in 16 cases, and poor in 3 cases with an excellent and good rate of 44.11% in the control group; and significant difference was shown between 2 groups（t=2.30, P=0.03）. SNQ was significantly lower in experimental group than in control group at 2 years after operation（t=55.03, P=0.00）, indicating that ligament healing was better in experimental group than control group. Conclusion Compared with simple clavicular hook plate fixation, the clavicular hook plate combined with trapezius muscle fascia for reconstruction of acromioclavicular and coracoclavicular ligaments is successful in treating acute complete acromioclavicular dislocations, with the advantages of higher ligament healing, less complication, and early improvement of shoulder functions.