切口ORTHOCORD线内固定、锁骨钩钢板、关节镜下带袢钢板治疗肩锁关节脱位Rockwood Ⅲ型的临床对比研究

Clinical Comparative Study of Small Incision ORTHOCORD Line Fixation,Clavicular Hook Plate Fixation,Arthroscopic Steel Belt Loop Treating Acromioclavicular Joint Dislocation Rockwood Ⅲ

目的比较小切口ORTHOCORD线内固定、锁骨钩钢板及关节镜下带袢位钢板治疗临床肩锁关节脱位RockwoodⅢ型的效果。方法选取2010年3月至2012年5月在瓦房店第三医院治疗的99例肩锁关节脱位RockwoodⅢ型患者为研究对象,采用随机数字表法分为三组,分别采用小切口ORTHOCORD线内固定(33例)、锁骨钩钢板(33例)、关节镜下带袢钢板(33例)治疗。观察三组患者的住院时间、手术时间、出血量、恢复工作时间手术费用、Constant评分的疼痛、日常活动水平、肩关节活动范围、力量、总分及自我评分系统(SSV)评分、视觉模拟评分(VAS)等指标并进行比较。结果小切口ORTHOCORD线内固定组住院时间[(5.0±1.2)d]、手术时间[(40±4)min]、出血量[(50.6±2.5)m L]、恢复工作时间[(20.3±2.3)d]、手术费用[(6300±1200)元]均低于锁骨钩钢板组[(8.8±1.5)d、(57±4)min、(67.3±4.6)m L、(34.7±5.1)d、(11 600±1100)元]和关节镜下带袢钢板组[(5.8±1.1)d、(50±4)min、(54.1±3.1)m L、(24.4±2.6)d、(184 00±1300)元],差异有统计学意义(P<0.05)。小切口ORTHOCORD线内固定组日常活动水平和总分低于锁骨钩钢板组[(13.7±2.6)分比(15.2±3.0)分,(69.7±12.8)分比(80.8±11.9)分],差异有统计学意义(P<0.05)。治疗后,小切口ORTHOCORD线内固定组SSV评分高于锁骨钩钢板组[(85.8±10.5)分比(70.3±11.1)分],VAS评分低于锁骨钩钢板组[(12.1±5.1)分比(22.0±4.9)分],差异有统计学意义(P<0.05)。结论小切口ORTHOCORD线内固定治疗肩锁关节脱位RockwoodⅢ型的临床效果显著,关节镜下带袢钢板疗效尚可,但恢复相对较差,锁骨钩钢板在恢复和临床疗效均存在一定局限性。

Objeetive To compare the effect of small incision ORTHOCORD line fixation, clavicular hook plate and arthroscopic steel belt loop in treatment of acromioclavicular joint dislocation Rockwood Ⅱ. Methods Total of 99 patients with acromioclavicular joint dislocation Rockwood Ⅲ admitted to Wafangdian City Third Hospital Co,Ltd. from Mar. 2010 to May 2012 were included in the study and divided into three groups according to random number table method, which were treated with small incision ORTHOCORD line fixation （ 33 cases ） and clavicular hook plate （ 33 cases ）, arthroscopic steel belt loop （ 33 cases）. The hospital stay, operative time, blood loss, recovery time, surgery costs, Constant scare of pain, daily activity level, shoul- der range of motion, strength, total score and self-scoring system （SSV） score, visual analogue scale （VAS） of the three groups were compared. Restflts Hospitalization time [ （ 5.0±1.2 ） d ], operation time [ （ 40± 4） min ], bleeding amount[ （50. 6±2.5 ） mL ], recovery working time [ （20.3± 2.3 ） d ], operation expenses [ （6300± 1200） yuan] of small incision ORTHOCORD line fixation group were lower than clavicular hook plate group [ （ 8. 8±1.5 ） d, （ 57±4 ） min, （ 67. 3± 4.6 ） mL, （ 34.7±5.1 ） d, （ 11 600±1100 ） yuan ] and arthroscopic steel belt loop group [ （5.8 ±1.1 ） d, （50±4） min, （54. 1±3.1 ） mL, （24. 4±2.6 ） d, （ 18 400±1300 ） yuan ], the differences were statistically significant （ P 〈 0. 05 ）. Daily activity level and totalscore of small incision ORTHOCORD line fixation group were lower than clavicular hook plate group [ （ 13.7±2.6 ） scores vs （ 15.2±3.0） scores, （ 69.7±12.8 ） scores vs （ 80.8±11.9 ） scores ], the differences were statistically significant （ P 〈 0.05 ）. SSV score of small incision ORTHOCORD line fixation group was higher than clavicular hook plate group [ （ 85.8±10, 5 ） scores vs （ 70. 3±11.1 ） scores ], and VAS score was lower than clavicular hook plate group[ （ 12. 1±5.1 ） scores vs （22.0±4. 9） scores] ,the differences were statistically significant （ P 〈 0.05 ）. Conclusion The small incision ORTHOCORD line fixation for acromioclavicular joint dislocation Rockwood 1I has significant clinical effect ; the effect of arthroscopic steel belt loop is acceptable but the recovery is less satisfactory;clavicular hook plate has limitations in both the recovery and clinical efficacy.