关节镜下带袢双钛板TightRope置入治疗肩锁关节脱位的疗效分析

Clinical effect of arthroscopic double titanium plate TightRope placement in the treatment of acromioclavicular joint dislocation

背景:RockwoodⅢ~Ⅵ型肩锁关节脱位常采用手术治疗,既往多为切开复位及刚性固定,后期逐渐出现并发症及相关功能障碍。如今微创及弹性固定是肩锁关节脱位手术治疗的新趋势。目的:研究关节镜下带袢双钛板TightRope置入治疗肩锁关节脱位的临床疗效。方法:选取2013年4月至2017年4月于我院治疗的32例肩锁关节脱位患者,均随访超过2年,男19例,女13例,年龄21~67岁,平均(35.9±5.7)岁,Rockwood分型Ⅲ型16例,Ⅳ型16例,其中20例采用关节镜辅助带袢双钛板TightRope置入内固定治疗,设为观察组,12例采用切开复位锁骨钩接骨板内固定治疗,设为对照组。记录围手术期相关指标及术后并发症发生情况,比较术前、术后7 d、1个月及末次随访疼痛视觉模拟评分(VAS)、美国加州大学洛杉矶分校肩关节系统评分(UCLA),末次随访根据X线片、关节活动度等评价手术综合疗效。结果:两组手术时间差异无统计学意义(P>0.05),观察组平均出血量、住院时间均低于对照组(P<0.05);两组术后7 d、1个月、末次随访VAS评分均低于术前,UCLA评分均高于术前(P<0.05),观察组术后7 d、1个月、末次随访UCLA评分高于对照组(P<0.05);末次随访观察组优良率为95.0%,对照组为91.7%,两组差异无统计学意义(P>0.05);观察组并发症发生率为5.0%,低于对照组的25.0%(P<0.05)。结论:关节镜下带袢双钛板TightRope置入治疗肩锁关节脱位能有效固定脱位肩锁关节,改善肩关节功能及疼痛症状,还有创伤小、并发症少及可早期功能锻炼等优点。

Background: Operation is the main therapy for the treatment of acromioclavicular joint dislocation of Rockwood Ⅲ-Ⅵ, and open reduction and rigid fixation used to be conducted which gradually led to some complications and dysfunction. Recently minimally invasive method and elastic fixation are the new trend for the treatment of acromioclavicular joint dislocation.Objective: To study the clinical effect of arthroscopic double titanium plate TightRope implantation in the treatment of acromioclavicular joint dislocation. Methods: Thirty-two patients with acromioclavicular joint dislocation treated in our hospital from April 2013 to April 2017 were included, followed up for more than 2 years, including 19 males and 13 females, aged(35.9±5.7)years(range, 21-67) with 16 patients of Rockwood type Ⅲ and 16 patients of type Ⅳ. Twenty patients were treated with arthroscopy-assisted double titanium plate TightRope implantation and internal fixation as observation group, and 12 patients were treated with open reduction and internal fixation of TightRope clavicle hook bone plate as the control group. The perioperative related indexes and postoperative complications were recorded, and the visual analogue scores(VAS) and the University of California Los Angeles Shoulder Joint System(UCLA) score before surgery, 7 days, 1 month after surgery and last follow-up were compared. At the last follow-up, the comprehensive curative effect was evaluated according to X-ray films and joint mobility.Results: There was no significant difference in operation time between the two groups(P>0.05). The average bleeding volume and hospital stay were lower in the observation group than in the control group(P<0.05). The VAS scores of the two groups were lower and the UCLA scores were higher than those before the operation at 7 days, 1 month and last follow-up(P<0.05). The UCLA score was higher in the observation group than in the control group at 7 days,1 month and last follow-up after operation(P<0.05). The good rate at the last follow-up was 95.0% in the observation group and 91.7% in the control group(P>0.05). The complication rate was lower in the observation group than in the control group(5.0% vs. 25.0%, P<0.05). Conclusions: Arthroscopic double titanium plate TightRope implantation can effectively fix the dislocated acromioclavicular joint, improve shoulder function and pain symptoms, with the advantages of less trauma, less complications and early functional exercise.