自体腓骨长肌腱前侧半重建喙锁韧带与钩钢板固定治疗Rockwood Ⅲ～Ⅴ型肩锁关节脱位疗效观察

Therapeutic effect of anterior semi-reconstruction of the patellofemoral ligament and hook plate fixation in the treatment of Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation

目的探究自体腓骨长肌腱前侧半(AHPLT)重建喙锁韧带与钩钢板固定治疗RockwoodⅢ~Ⅴ型肩锁关节脱位患者的临床效果。方法前瞻性选取2013年1月至2018年5月宝鸡市人民医院骨科诊治的肩锁关节脱位患者86例,根据随机数表法分为对照组和观察组各43例。对照组行钩钢板固定治疗,观察组行自体AHPLT重建喙锁韧带治疗。比较两组患者的基础指标、术前及术后12个月的肩关节功能评分(Constant-Murley)和并发症。结果观察组患者的手术时间为(86.47±10.58)min,明显长于对照组的(52.36±7.41)min,住院天数为(8.65±1.27)d,明显短于对照组的(10.23±1.56)d,差异均有统计学意义(P<0.05);术后12个月,两组患者的Constant-Murley评分均较术前提高,观察组患者的Constant-Murley疼痛评分及总分分别为(12.48±2.25)分、(80.09±10.72)分,明显高于对照组的(10.07±1.62)分、(74.61±9.87)分,差异均有统计学意义(P<0.05);观察组患者的肩峰下滑囊炎、肩锁关节周围疼痛及并发症总发生率分别为0、0、6.98%,明显低于对照组的9.30%、6.98%、37.21%,差异均有统计学意义(P<0.05)。结论RockwoodⅢ~Ⅴ型肩锁关节脱位患者行自体AHPLT重建喙锁韧带治疗的手术时间更长,但可明显减轻疼痛,改善肩关节功能,降低并发症率,安全可靠。

Objective To explore the clinical effect of the anterior half of the iliac crest (AHPLT) reconstruction of the sacral ligament and hook plate fixation in the treatment of Rockwood type Ⅲ-Ⅴ acromioclavicular joint dislocation. Methods A total of 86 patients with acromioclavicular joint dislocation, who admitted to Department of Orthopedics of Baoji People's Hospital from January 2013 to May 2018, were prospectively selected and divided into two groups according to random number table method, with 43 cases in each group. The control group was treated with hook plate fixation, and the study group was treated with autologous AHPLT to reconstruct the sacral ligament. Baseline indicators, shoulder joint function score before and 12 months after surgery (Constant-Murley), and complications were compared between the two groups. Results The operation time of the study group was (86.47±10.58) min, which was significantly longer than (52.36±7.41) min of the control group (P<0.05). The hospitalization days of the study group were (8.65±1.27) d, which was significantly shorter than (10.23±1.56) d of the control group (P<0.05). At 12 months after operation, the Constant-Murley scores of the two groups were higher than those before surgery. The Constant-Murley pain score and total score of the study group were (12.48±2.25) points and (80.09±10.72) points, which were significantly higher than (10.07±1.62) points and (74.61±9.87) points of the control group (all P<0.05). The shoulder apical bursitis, pain around the acromioclavicular joint and the overall incidence of complications in study group were 0, 0, and 6.98%, respectively, which were significantly lower than corresponding 9.30%, 6.98%, and 37.21% of the control group (all P< 0.05). Conclusion The operation time of the treatment of autologous AHPLT reconstruction of the sacral ligament Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation patients is longer, but it can significantly reduce pain, improve shoulder function, reduce the complication rate, which is safe and reliable.