关节镜辅助下Tightrope袢钢板与锁骨钩钢板治疗RockwoodⅢ型肩锁关节脱位的疗效

Clinical effect of arthroscopy-assisted Tightrope plate and clavicular hook plate for RockwoodⅢacromioclavicular joint dislocation

目的探讨关节镜辅助下Tightrope袢钢板与锁骨钩钢板治疗RockwoodⅢ型肩锁关节脱位的疗效。方法回顾性分析2016年1月—2018年12月四川省广元市中医医院骨科行RockwoodⅢ型肩锁关节脱位患者60例,男性29例,女性31例;年龄19~75岁,平均45.1岁;运动伤5例,摔伤20例,道路交通伤32例,砸伤3例。按固定方式不同分为袢钢板组(23例)和锁骨钩组(37例),袢钢板组行关节镜辅助下Tightrope袢钢板,锁骨钩组行切开复位锁骨钩钢板内固定。比较两组患者手术时间、切口长度、出血量、喙锁关节间隙及肩锁关节间隙,术后1、6个月视觉模拟评分(VAS),肩关节Constant-Murley功能评分等指标。结果患者均获得随访,随访时间6~22个月,平均15.8个月。袢钢板组手术时间(45.82±23.91)min、切口长度(3.74±1.98)cm及出血量(30.45±6.15)mL均显著少于锁骨钩组(54.64±30.72)min、(7.96±1.04)cm、(70.49±10.18)mL,差异有统计学意义(t=3.143,P=0.024;t=2.482,P=0.008;t=5.661,P=0.023)。两组患者喙锁关节间隙、肩锁关节间隙影像学指标方面比较,差异无统计学意义(t=0.345,P=0.192;t=0.432,P=0.243)。所有患者VAS与Constant-Murley评分随时间增加显著好转。袢钢板组VAS术后1个月(2.3±1.1)分、6个月(1.3±0.5)分显著低于锁骨钩组(3.9±2.1)分、(2.7±1.9)分,差异有统计学意义(t=0.824,P=0.046;t=1.834,P=0.028)。Constant-Murley评分方面,袢钢板组术后1个月(72.1±15.4)分、6个月(91.3±12.9)分显著高于锁骨钩组(60.5±13.4)分、(82.1±18.4)分,差异有统计学意义(t=1.524,P=0.026;t=4.513,P=0.017)。结论关节镜辅助下Tightrope袢钢板治疗RockwoodⅢ型肩锁关节脱位安全有效,能够有效提高患者生活质量,值得临床推广。

Objective To investigate the clinical effect of arthroscopy-assisted Tightrope plate for Rockwood typeⅢacromioclavicular dislocation.Methods A retrospective analysis was conducted in 60 patients with RockwoodⅢacromioclavicular joint dislocation who were admitted in the Department of Orthopedics,Guangyuan City Hospital of Traditional Chinese Medicine,Sichuan Province,from Jan.2016 to Dec.2018.There were 29 males and 31 females.The average age was 45.1(19-75)years.There were 5 cases of sports injury,20 cases of traffic injury,32 cases of traffic injury,and 3 cases of smashing injury.According to different fixation methods,the 60 patients were divided into Tightrope plate group(23 patients treated with arthroscopy-assisted Tightrope plate)and clavicular hook group(37 patients treated with open reduction clavicular hook plate internal fixation).Surgical time,incision length,bleeding volume,coracoclavicular joint space and acromioclavicular joint space,visual analogue scale(VAS)after 6 months,Constant-Murley functional score of shoulder joint,complications and other indicators were evaluated.Results All patients were followed up for 6-22(15.8)months.The operation time(45.82±23.91)minutes,incision length(3.7±1.9)cm,and blood loss(30.4±6.1)mL in the Tightrope plate group were all less than those in the clavicular hook group(54.64±30.72)minutes,(7.9±1.0)cm,(70.4±10.1)mL,with statistically significant differences(t=3.143,P=0.024;t=2.482,P=0.008;t=5.661,P=0.023).In terms of imaging indexes of the space between the coracoclavicular joint and the acromioclavicular joint,there was no significant difference between the two groups(t=0.345,P=0.192;t=0.432,P=0.243).VAS and Constant-Murley score of all patients improved significantly with time.VAS in the Tightrope plate group(2.3±1.1)points,(1.3±0.5)points]was significantly lower than that in the clavicular hook group[(3.9±2.1)points,(2.7±1.9)points]at 1 and 6 months after surgery,with a statistically significant difference(t=1.834,P=0.028).Constant-murley shoulder function score in the Tightrope plate group[(72.1±15.4)points,(91.3±12.9)points]was significantly higher than that in the clavicular hook group[(60.5±13.4)points,(82.1±18.4)points]at 1 and 6 months after surgery,with a statistically significant difference(t=1.524,P=0.026;t=4.513,P=0.017).Conclusion Arthroscopy-assisted tightrope plate for the treatment of Rockwood typeⅢacromioclavicular dislocation is safe and effective,and can effectively improve the quality of life of patients,which is worthy of extensive clinical promotion.