手术治疗Rockwood Ⅲ型急性肩锁关节脱位的术式选择

Surgical Treatment of Rockwood Type Ⅲ Acute Dislocation of the Shoulder Joint

目的:对比研究关节镜下自体半腱肌肌腱重建喙锁韧带以及肩锁韧带和锁骨钩钢板治疗RockwoodⅢ型急性肩锁关节脱位的疗效。方法:从2010年5月至2013年4月,选择我院82例RockwoodⅢ型急性肩锁关节脱位病患。以数字法随机分为观察组(42例)以及对照组(40例)。对照组行锁骨钩钢板治疗,观察组行关节镜下自体半腱肌肌腱重建喙锁韧带及肩锁韧带治疗。随访一年,对比两组有关疗效。结果:两组术后Constant-Murley评分比较差异不明显,无统计学意义(均P>0.05),但观察组在改善病患疼痛方面疗效显著,差异均有统计学意义(P<0.05)。两组病患术后CC-Dist值均明显改善,但是治疗前后两组之间比较差异不明显,无统计学意义(均P>0.05)。观察组疗效为优者占比66.67%(28/42),优良率为97.62%(41/42),均显著高于对照组的37.50%(15/40),75.00%(30/40),差异均有统计学意义(均P<0.05)。结论:关节镜下自体半腱肌肌腱重建喙锁韧带以及肩锁韧带和锁骨钩钢板治疗RockwoodⅢ型急性肩锁关节脱位,两者均能调节肩关节作用,但是前者能较好的改善病患疼痛情况。

Objective:To study the arthroscopic semitendinosus tendon reconstruction of coracoclavicular and acromioclavicular ligament and clavicular hook plate in the treatment of Rockwood type III acromioclavicular joint dislocation.Methods:From 2010 May to 2013 April in our hospital,82 Rockwood type III acromioclavicular joint dislocation patients.The figures were randomly divided into the observation group(42 cases) and control group(40 cases).The control treatment group was treated with clavicular hook plate,the observation group underwent arthroscopic semitendinosus tendon reconstruction of coracoclavicular and acromioclavicular ligament treatment,compared two groups of curative effect after follow up for 1 year.Results:Constant Murley scores were compared between two groups after operation had no obvious statistical significance(P>0.05),but compared with the control group,the observation group in improving pain effect was significant,the differences were statistically significant(P<0.05).Two groups of patients with postoperative CC-Dist values than before treatment were significantly improved after treatment,but the difference between the two groups was not obvious,no statistical significance(P>0.05).The curative effect of therapeutic group was excellent accounted for more than 66.67%(28/42),the excellent and good rate was 97.62%(41/42),which were significantly higher than those in control group 37.50%(15/40),75%(30/40).The differences were statistically significant(P<0.05).Conclusion:Arthroscopic semitendinosus tendon reconstruction of coracoclavicular and acromioclavicular ligament and clavicular hook plate in the treatment of Rockwood type III acromioclavicular joint dislocation,both of which can adjust the shoulder joint function,but the former can alleviate pain.