喙锁螺钉与锁骨钩钢板治疗Rockwood Ⅲ～Ⅴ型肩锁关节脱位的比较研究

Comparative study of coraco-clavicular screw and clavicular hook plate in treatment of Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation

目的比较喙锁螺钉与锁骨钩钢板治疗RockwoodⅢ~V型肩锁关节脱位的疗效。方法2011年3月~2018年6月选取我院收治72例RockwoodⅢ~V型肩锁关节脱位患者。根据手术方法进行分组,喙锁螺钉固定组34例,锁骨钩钢板固定组38例。两组患者临床结果进行对比分析。结果与锁骨钩钢板固定组相比,喙锁螺钉固定组手术时间、术中出血量、切口长度相对较小,差异有统计学意义(P<0.05)。内固定术后2周,喙锁螺钉固定组Constant评分低于锁骨钩钢板固定组(P<0.05);但在内固定去除后2周,两组Constant评分比较差异无统计学意义(P>0.05)。内固定去除前后两组Constant评分差异均有统计学意义(P<0.05)。喙锁螺钉组术后2例出现早期螺钉退出。钩钢板组术后8例出现肩峰下骨溶解,其中3例合并明显的肩峰撞击综合征;1例钢板去除后再发肩锁关节脱位,1例出现皮下感染。结论喙锁螺钉治疗肩锁关节脱位的早期疗效低于锁骨钩钢板,但内固定去除后两者疗效相当,锁骨钩钢板组有较高并发症发生率。

Objective To compare the efficacy of coraco-clavicular screw and clavicular hook plate in the treatment of RockwoodⅢ~Ⅴacromioclavicular joint dislocation.Methods Seventy-two patients with RockwoodⅢ-Ⅴacromioclavicular joint dislocation who were admitted to our hospital from March 2011 to June 2018 were enrolled in the study.According to the surgical method,34 patients were treated with coraco-clavicular screw and 38 patients were treated with clavicular hook plate.The clinical outcomes of the two groups were compared and analyzed.Results The operation time,intraoperative blood loss and incision length were smaller in the coraco-clavicular screw group than those in the clavicular hook plate,with statistically significant differences(P<0.05).Two weeks after internal fixation,the Constant score of the coraco-clavicular screw group was lower than that of the clavicular hook plate group(P<0.05).However,there was no statistically significant difference of Constant score between the two groups 2 weeks after the removal of internal fixator(P>0.05).The differences of the Constant score in each group before and after the removal of internal fixator were statistically significant(P<0.05).Early cochlear screw withdrawal occurred in 2 patients in the coracoclavicular screw group.In the hook plate group,8 cases had subacromial osteolysis after operation,of which 3 cases had obvious acromion impact syndrome;1 case had acromioclavicular joint dislocation after removal of the plate,and 1 case had subcutaneous infection.Conclusion The early efficacy of coraco-clavicular screw is lower than that of the clavicular hook plate in the treatment of acromioclavicular joint dislocation.However,the effect is equivalent after the removal of internal fixator.The clavicular hook plate group has a higher incidence of complications.