袢钢板内固定与外展支具固定治疗Rockwood Ⅲ型肩锁关节脱位的疗效比较

The Clinical Efficacy Comparison of Loop Plates and Abducens Orthosis Treatment for Rockwood Ⅲ Acromioclavicular Joint Dislocation

目的比较袢钢板内固定与外展支具固定治疗RockwoodⅢ型肩锁关节脱位的临床疗效。方法对本院2015年1月至2017年2月收治的41例RockwoodⅢ型肩锁关节脱位患者进行回顾性对比分析,分为手术治疗组(袢钢板内固定) 23例,保守治疗组(外展支具固定) 18例,并对两组病人进行治疗后1年随访,采用Constant-Murlery评分比较治疗后1周、3个月、6个月和1年时的肩关节功能。结果在手术治疗组中,有1例患者复位不完全,余22例(95. 7%)术后无复发。保守治疗组中2例因不能耐受牵引固定而改用其他治疗手段,余16例(88. 9%)治疗后复查无再次脱位。两组治愈率差异无统计学意义(χ~2=0. 681,P=0. 407)。手术组与保守治疗组的Constant-Murlery评分,治疗后1周时分别为58. 94±4. 04和41. 17±3. 17(t=13. 270,P=0. 000); 3个月时分别为77. 56±3. 60和69. 37±3. 76(t=7. 742,P=0. 000); 6个月时分别为87. 89±2. 44和86. 72±2. 39(t=1. 536,P=0. 143); 1年时分别为87. 83±2. 20和88. 78±1. 31(t=0. 193,P=0. 098)。手术组在术后1周和3个月时Constant-Murlery评分优于保守组,但6个月和12个月时两组无明显差异。结论对于RockwoodⅢ型肩锁关节脱位,袢钢板内固定与外展支具固定治疗均能取得很好的疗效,但袢钢板内固定治疗在早期比保守治疗更有优势,但远期效果两者没有明显差异。

Objective To compare the treatment effects of loop plates internal fixation and abducens orthosis external fixation for the patients with RockwoodⅢacromioclavicular joint dislocation. Methods 41 patients with RockwoodⅢacromioclavicular dislocation in our hospital from January 2015 to February 2017 were analyzed retrospectively.There were 23 cases of the operation group underwent loop plates internal fixation(the operation group),and 18 cases underwent abducens orthosis external fixation(the control group). Results In the operation group,there was 1 patient suffered from the incomplete reduction,while the other 22 cases(95.7%)had no recurrence after operation.In the control group,there were 2 patients changed to other treatments because they could not tolerate the traction.The remaining 16 patients(88.9%)did not dislocate again after treatment.There was no significant difference in the cure rate between the two groups(χ^2=0.681,P=0.407).The 1-week,3-month,6-month and 12-month Constant-Murlery score of the operation group and the control group was 58.94±4.04 vs.41.17±3.17(t=13.270,P=0.000),77.56±3.60 vs.69.37±3.76(t=7.742,P=0.000),87.89±2.44 vs.86.72±2.39(t=1.536,P=0.143)and 87.83±2.20 vs.88.78±1.31(t=0.193,P=0.098)respectively.It was obviously better of the 1-week and 3-month Constant-Murlery scores in the operation group.But there was no significantdifference between the two groups 6 and 12 months after operation. Conclusion For RockwoodⅢacromioclavicular dislocation,both loop plates internal fixation and abducens orthosis external fixation can achieve good treatment effect.Surgery is more advantageous than non-operation treatment in the early stage,but there is no difference between the two treatments in long-term follow-up.