韧带重建与钩钢板治疗肩锁关节脱位效果分析

Effect of ligament reconstruction and hook plate on acromioclavicular dislocation

目的对比分析肩关节镜下重建喙锁韧带及锁骨钩钢板治疗肩锁关节脱位的临床效果。方法回顾性分析2015年1月—2016年5月广州花都区人民医院骨科收治的RockwoodⅢ~Ⅴ型肩锁关节脱位患者41例,男性30例,女性11例;年龄20~37岁,平均31.7岁;均为直接暴力伤。按治疗方法不同分为重建组19例,内固定组22例。重建组接受肩关节镜下喙锁韧带重建,内固定组接受锁骨钩钢板内固定。比较两组手术出血量、手术时间,采用VAS评分、美国肩肘外科医师评分(ASES)、肩关节外展、外旋、内旋活动度评估肩关节功能,比较两组术后12个月的肩关节功能。结果重建组患者手术时间(66.05±2.58)min较内固定组(64.06±3.10)min稍长,术中出血量(51.32±5.49)mL较内固定组(75.23±5.87)mL少,差异均有统计学意义(P<0.05)。两组术后疼痛均较术前明显改善,重建组术后6周,3、6个月肩关节功能较内固定组更佳[术后6周重建组ASES(89.73±2.13)分,内固定组(83.86±1.78)分;术后3个月重建组(96.84±1.50)分,内固定组(91.18±1.74)分;术后6个月重建组(92.63±1.67)分,内固定组(85.05±1.21)分],差异有统计学意义(P<0.05)。内固定组拆除内固定后12个月与同期重建组肩关节功能比较差异无统计学意义。结论肩关节镜下重建喙锁韧带治疗肩关节脱位近期疗效优于锁骨钩钢板,但锁骨钩钢板拆除后依然能恢复良好的肩关节功能。

Objective To compare the clinical effect of reconstruction of coracoid ligament under arthroscopy and clavicular hook plate in the treatment of dislocation of acromioclavicular joint.Methods A retrospective analysis was conducted in 41 patients with typeⅢ-Ⅴacromioclavicular joint dislocation,who were admitted into our hospital from Jan.2015 to May 2016.The patients were divided into reconstruction group(19 cases)and internal fixation group(22 cases)according to the treatment methods.There were 30 males and 11 females,with an average age of 31.7 years(range,20-37 years).All patients were injured by direct violence.Patients in the reconstruction group received arthroscopic coracoid ligament reconstruction,and patients in the internal fixation group received clavicle hook plate internal fixation.The blood loss and operation time of the two groups were compared.VAS score,American Shoulder and Elbow Surgeon score(ASES),shoulder joint abduction,external rotation,internal rotation range of motion were used to evaluate shoulder joint function.The shoulder joint function of the two groups was compared at 12 months after operation.Results The operation time of the reconstruction group was(66.05±2.58)min,longer than that of the internal fixation group(64.06±3.10)min;the intraoperative blood loss of the reconstruction group was(51.32±5.49)mL,less than that of the internal fixation group(75.23±5.87)mL,and the differences were statistically significant(P<0.05).Postoperative pain was significantly improved compared with preoperatively.The shoulder joint function of the reconstruction group was better than that of the internal fixation group at 6 weeks,3 and 6 months after the operation(ASES at 6 weeks after operation in the reconstruction group:89.73±2.13,internal fixation group:83.86±1.78;at 3 months after operation in the reconstruction group:92.63±1.67,internal fixation group:85.05±1.21;at 6 months after operation in the reconstruction group:96.84±1.50,internal fixation group:91.18±1.74),and the differences were statistically significant(P<0.05).There was no significant difference in shoulder joint function between the internal fixation group and the reconstruction group at 12 months after the internal fixation was removed.Conclusion Arthroscopic ligament reconstruction in the treatment of shoulder joint dislocation shows good clinical short term effect,small trauma,little bleeding,good functional recovery satisfaction and short-term curative effect.But good shoulder joint function can be obtained after the hook plate is removed.