关节镜辅助Tightrope钢板与锁骨钩钢板内固定治疗成人RockwoodⅢ型肩锁关节脱位的疗效比较

Comparison of arthroscopy-assisted Tightrope technique and clavicular hook plating for acromioclavicular joint dislocation of Rockwood typeⅢ

目的比较关节镜辅助Tightrope钢板与锁骨钩钢板内固定治疗成人RockwoodⅢ型肩锁关节脱位的疗效。方法回顾性分析2012年1月至2015年12月金华市中心医院骨一科收治的60例RockwoodⅢ型肩锁关节脱位患者资料。年龄34~62岁(平均40岁)。左侧28例,右侧32例。患者按治疗方式不同分为2组:Tightrope组30例和钢板组30例。统计并对比两组患者切口长度、手术时间、失血量及术后3、12个月的视觉模拟评分(VAS)评分和Constant-Murley肩关节功能评分以评价两组患者临床疗效。结果Tightrope组和钢板组成人RockwoodⅢ型肩锁关节脱位患者的性别、年龄、受伤侧别、骨折Rockwood分型、致伤原因等比较差异无明显统计学意义(P>0.05),具有可比性。60例患者术后获6~12个月(平均10个月)随访。两组患者切口一期愈合,无神经损伤并发症。Tightrope组的切口长度[(3.4±0.6)cm]明显较短,失血量[(40.0±8.2)mL]明显均较钢板组[(8.8±1.8)cm、(70.9±9.8)mL]低,差异均有统计学意义(P<0.05)。术后3、12个月,Tightrope组患者VAS评分[(2.2±1.1)、(1.1±0.9)分]和Constant-Murley肩关节功能评分[(85.5±2.1)、(98.0±3.1)分]明显较钢板组[(3.2±1.8)、(2.1±1.2);(75.0±4.1)、(85.1±2.9)分]更优,差异均有统计学意义(P<0.05)。随访期间两组均无明显并发症发生。结论关节镜辅助Tightrope钢板与锁骨钩钢板内固定治疗成人RockwoodⅢ型肩锁关节脱位均能缓解肩关节疼痛。与后者比较,前者治疗方案具有切口小、出血少、VAS评分低的特点,而且无需取出,减轻患者的痛苦和经济负担。

Objective To compare the clinical outcomes of arthroscopy-assisted Tightrope technique and clavicular hook plating for the treatment of acromioclavicular joint dislocation of Rockwood TypeⅢin adults.Methods The clinical data were reviewed of the 60 patients who had been treated for acromioclavicular joint dislocation of Rockwood TypeⅢfrom January 2012 to December 2015 at Department of Orthopedics,Jinhua Municipal Central Hospital.Their age ranged from 34 to 62 years(mean,40 years).Injury was at the left side in 28 cases and at the right in 32 ones.They were randomly assigned to receive treatment either using arthroscopy-assisted Tightrope technique(group A,30 cases)or using clavicular hook plate(group B,30 cases).The 2 groups were compared in terms of incision length,operation time,blood loss,visual analogue scale(VAS)and Constant-Murley shoulder function scores at postoperative 3 and 12 months.Results The 2 groups were compatible because there were no significant between-group differences in gender,age,injury laterality,Rockwood fracture typing or injury cause(P>0.05).All the patients were followed up for a mean of 10 months(from 6 to 12 months).Primary incision healing was achieved in both groups with no neural lesion.The incision length in group A(3.4±0.6 cm)was significantly shorter than that in group B(8.8±1.8 cm),and the blood loss in the former(40.0±8.2 mL)significantly less than that in the latter(70.9±9.8 mL)(P<0.05).The VAS scores and Constant-Murley shoulder function scores at postoperative 3 and 12 months in group A(respectively:2.2±1.1 and 1.1±0.9 points;85.5±2.1 and 98.0±3.1 points)were significantly better than those in group B(respectively:3.2±1.8 and 2.1±1.2 points;75.0±4.1 and 85.1±2.9 points)(P<0.05).There were no obvious complications during the follow-up period in either group.Conclusions Although both arthroscopy-assisted Tightrope technique and clavicular hook plating can relieve shoulder pain in the adult patients with acromioclavicular joint dislocation of Rockwood TypeⅢ,the former shows advantages of a smaller incision,less bleeding,lower VAS scores,and reduced pain and financial cost for the patients due to no trouble of implant removal.