两种内固定方式治疗肩锁关节脱位的疗效对比

Comparison of two kinds of internal fixation for acromioclavicular dislocation

[目的]比较自主设计的组合铰链式肩峰-锁骨解剖板与常规锁骨钩钢板在治疗肩锁关节脱位中的效果。[方法]收集2016年10月~2017年10月本科收治的肩锁关节脱位患者68例(68肩),随机分为两组。其中,采用自行设计的组合铰链式肩峰-锁骨解剖板固定32例(铰链组),采用锁骨钩钢板行切开复位内固定36例(钩钢板组)。比较两组手术时间、切口长度、失血量、并发症、Constant肩关节功能评分以及影像测量和观察指标。[结果]所有患者顺利完成手术,无重要神经、血管损伤。两组在切口长度、手术时间、失血量的差异无统计学意义(P>0.05)。铰链组中糖尿病患者出现皮肤浅表感染2例。钩钢板组出现肩痛5例,浅表感染1例,外展活动受限4例。铰链组的并发症发生率显著低于钩钢板组,差异有统计学意义(P<0.05)。所有患者随访12~18个月,平均(15.24±3.57)个月。两组Constant评价均随时间推移而显著增加(P<0.05)。术前两组Constant评分差异无统计学意义(P>0.05),术后各时间点铰链组Constant评分均显著高于钩钢板组(P<0.05)。影像方面,术后两组间喙锁间隙差异无统计学意义(P>0.05),而铰链组肩锁间隙显著小于钩钢板组,差异有统计学意义(P<0.05)。[结论]组合铰链式肩峰、锁骨解剖板有锁骨钩钢板相同的复位固定效果,更有利于患者肩关节功能的恢复。

[Objective] To compare the clinical outcome of hinged acromion-claricle plate developed by ourselves versus conventional hook plate for treatment of dislocation of acromioclavicular joint.[Methods] From October 2016 to October 2017,a total of 68 patients(68 shoulders) who were candidates of surgical treatment for acromioclavicular dislocation were randomly divided into two groups. Of them, 32 patients had open reduction and internal fixation(ORIF) with the hinged acromion-clavicle plate(the hinged plate group), while the remaining 36 patients were treated with conventional clavicular hook plate(the hook plate group). The operation time, incision length, intraoperative blood loss, complications, Constant score and parameters measured radiographically were compared between the two groups.[Results] All the patients in both groups had surgical procedures performed successfully without iatrogenic neurovascular injuries. There were no statistically significant differences in operation time, intraoperative blood loss between the two groups(P<0.05). By contrast, only 2 patients with diabetes got superficial in the hinged plate group, whereas 5 patients of considerable shoulder pain, 1 of superficial wound infection and 4 of abduction limitation were noticed in the hook plate group, therefore, the hinged plate group had significantly less complications than the hook group(P<0.05). All patients were followed up for 12~18 months with an average of(15.24±3.57) months. The Constant score significantly increased over time in both groups(P<0.05). The hinged plate group proved significantly superior to the hook plate group in Constant score at each time point after operation(P<0.05), although no a statistically significant difference was found before operation in the score between them(P>0.05). In term of radiographic assessment, the hinged plate group had significantly less acromioclavicular distance than the hook plate group postoperatively(P<0.05), despite the fact that no a statistically significant difference in coracoclavicaular distance was noticed postoperatively between the two group(P>0.05).[Conclusions] This hinged acromion-clavicle plate not only achieve satisfactory reduction of acromioclavicular dislocation similar to the hook plate, but also more greatly facilitate the function recovery than the hook plate.