锁骨钩钢板联合双股不可吸收线固定治疗急性TossyⅢ型肩锁关节脱位的临床研究

Clinical study on treatment of acute Tossy type Ⅲ acromioclavicular joint dislocation with clavicular hook plate and double-stranded non-absorbable wire fixation

目的探讨锁骨钩钢板联合双股不可吸收线固定治疗急性TossyⅢ型肩锁关节脱位的临床疗效。方法前瞻性对比研究2015年5月—2018年5月重庆医科大学附属第三医院骨与创伤中心收治的急性TossyⅢ型肩锁关节脱位患者41例,男性30例,女性11例;年龄18~54岁,平均37.4岁。按照随机数字表分法为传统组(20例)和联合组(21例),传统组行单纯锁骨钩钢板内固定治疗肩锁关节脱位,联合组在传统锁骨钩钢板内固定治疗基础上联合双股不可吸收线辅助固定喙锁关节治疗,统计分析比较两组患者手术切口瘢痕长度、手术时间及术中出血量、肩关节前屈活动度、外展活动度、VAS评分、Constant-Murley评分及Karlsson评分以及内固定取出后1年内并发症发生情况。结果患者均顺利完成手术,术后门诊随访12~18个月,平均14.0个月。传统组与联合组在手术切口瘢痕长度(5.6±0.9)cm vs.(6.8±0.8)cm及术中出血量方面(48.7±8.5)mL vs.(50.1±7.8)mL差异无统计学意义(P>0.05);手术时间传统组显著低于联合组(55.3±6.8)min vs.(70.5±7.3)min,P<0.05;术后13个月肩关节前屈活动度、外展活动度联合组显著优于传统组(109.7±13.2)°vs.(90.2±0.75)°、(98.6±11.5)°vs.(80.5±8.7)°,P<0.05;术后12个月VAS评分联合组显著低于传统组(2.0±0.7)分vs.(3.0±1.5)分,P<0.05;术后14个月Constant-Murley评分及Karlsson评分,联合组显著优于传统组(90.1±3.0)分vs.(80.2±4.0)分、95%vs.60%,P<0.05。联合组内固定取出后未见关节再发脱位,出现锁骨远端骨性融合1例;传统组内固定取出后出现复位丢失2例,锁骨远端骨吸收及骨性融合2例,在术后1年出现类似肩峰撞击征阳性症状1例。结论锁骨钩钢板联合双股不可吸收线固定治疗急性TossyⅢ型肩锁关节脱位手术操作简单、关节固定牢靠,术后疼痛轻,临床疗效较单纯钢板内固定满意。

Objective To investigate the clinical effect of clavicular hook plate combined with doublestranded non-absorbable wire fixation in the treatment of acute Tossy type Ⅲ acromioclavicular joint dislocation.Methods Designed by prospective investigation,41 patients with Tossy type Ⅲ acromioclavicular joint dislocation admitted to our hospital from May 2015 to May 2018 were selected as the research objects.There were 30 males and11 females with an average age of 37.4(18-54) years.According to the random number table,they were divided into traditional group(20 cases) and combined group(21 cases).The traditional group was treated with simple clavicular hook plate internal fixation for acromioclavicular joint dislocation.The combined group was treated with traditional clavicular hook plate combined with double-stranded non-absorbable wire internal fixation for acromioclavicular joint dislocation.The scar length,operative time,bleeding volume,shoulder flexion,abduction,VAS score,Constant-Murley score and Karlsson score and complications at 1 year after fixation removal were compared between the two groups.Results The patients were all successfully operated and the average follow-up time was 14.0 months(12-18 months).Statistical analysis showed that there was no significant difference in scar length [(5.6±0.9) cm vs.(6.8±0.8) cm] and intraoperative blood loss [(48.7±8.5) mL vs.(50.1±7.8) mL] between the traditional group and the combined group(P> 0.05).In terms of operation time,the traditional group was significantly lower than that of the the combined group(55.3±6.8) min.At 13 months postoperatively,the combined group was significantly better than the traditional group in terms of shoulder flexion and abduction activities [(109.7±13.2)°vs.(90.2±0.75)°,(98.6±11.5)°vs.(80.5±8.7)°],P <0.05;at 12 months postoperatively,in terms of VAS score,the combined group was significantly lower than the traditional group [(3.0±1.5) points vs.(2.0±0.7)points].At 14 months after operation,the Constant-Murley score and Karlsson score in the combined group were significantly better than the traditional group [(90.1±3.0) points vs.(80.2±4.0) points,95% vs.60%,P <0.05].In the combined group,there was no re-dislocation of the joint after removal of the internal fixation,and 1 case of distal clavicular bone fusion after removal of the internal fixation;in the traditional group,there were 2 cases of loss of reduction after removal of the internal fixation,2 cases of distal clavicular bone absorption and bone fusion,and 1 case of positive symptoms similar to the acromion impingement syndrome at 1 year after operation.Conclusion The clavicular hook plate combined with double-strand non-absorbable wire fixation for acute Tossy type Ⅲ acromioclavicular joint dislocation is simple,economical,reliable and has slight pain.The clinical effect is more satisfactory than that of simple plate fixation.