增加缝线孔的锁骨钩钢板与传统钩钢板治疗急性肩锁关节脱位的比较研究

Comparison of clavicular hook plate with extra suture hole and traditional hook plate in the treatment of acute acromioclavicular dislocation

目的比较增加缝线孔的锁骨钩钢板与传统锁骨钩钢板治疗急性肩锁关节脱位的临床疗效。方法回顾性分析2017年3月至2020年9月手术治疗的创伤性肩锁关节脱位患者资料,根据固定方式分为传统锁骨钩钢板组和三角稳定固定组(使用增加缝线孔的锁骨钩钢板固定)。传统锁骨钩钢板组27例,男18例、女9例;年龄(37.56±8.94)岁;左侧16例,右侧11例;砸伤10例,交通伤9例,运动损伤8例;根据Rockwood分型:Ⅲ型9例,Ⅳ型10例,Ⅴ型8例。三角稳定固定组20例,男15例、女5例;年龄(38.95±9.91)岁;左侧13例,右侧7例;砸伤9例,交通伤8例,运动损伤3例;根据Rockwood分型:Ⅲ型5例,Ⅳ型9例,Ⅴ型6例。分别比较两组患者的手术时间、术中出血量、术后喙锁间隙、视觉模拟评分(visual analogue scale,VAS)、肩关节Constant-Murley评分。结果传统锁骨钩钢板组和三角稳定固定组手术时间分别为(51.07±11.27)min、(55.65±8.59)min,术中出血量分别为(87.41±15.34)ml、(90.50±14.32)ml,差异均无统计学意义(t=1.52,0.70;P>0.05)。两组患者术后均获得随访,随访时间为12~14个月,平均12.28个月。术后6个月,三角稳定固定组喙锁间隙为(11.26±0.70)mm,传统锁骨钩钢板组为(12.16±0.90)mm,差异有统计学意义(t=3.70,P<0.001)。三角稳定固定组术后第2天、3、6、12个月的VAS评分[分别为(1.80±0.77)分、0.00(0.00,1.00)分、0.00(0.00,0.00)分、0.00(0.00,0.00)分]小于传统锁骨钩钢板组[分别为(4.22±1.25)分、2.00(1.00,3.00)分、1.00(0.00,1.00)分、0.00(0.00,1.00)分],差异有统计学意义(t=7.65,P<0.001;Z=4.85,P<0.001;Z=3.44,P=0.001;Z=2.96,P=0.003)。三角稳定固定组术后第3、6、12个月的Constant-Murley评分[分别为(87.00±5.18)分、(91.25±2.75)分、(92.30±2.74)分]高于传统锁骨钩钢板组[分别为(76.96±5.21)分、(83.22±3.86)分、(85.22±3.49)分],差异有统计学意义(t=6.54,7.93,7.51;P<0.001)。传统锁骨钩钢板组手术并发症发生率70%(19/27),高于三角稳定固定组5%(1/20)。结论采用增加缝线孔的锁骨钩钢板治疗急性肩锁关节脱位可获得满意的临床疗效,较采用传统锁骨钩钢板固定更有利于早期恢复肩关节功能,减少术后并发症。

Objective To compare the clinical effective of clavicular hook plate with extra suture hole and traditional hook plate in the treatment of acute acromioclavicular dislocation.Methods This study retrospectively analyzed the clinical data of traumatic acromioclavicular dislocation patients who were treated by operation from March 2017 to September 2020.The patients were included in traditional hook plate(THP)group and triangle stabilization technique hook plate(TSTHP)group according fracture fixations.TSTHP group adopted clavicular hook plate with extra suture hole.There were 27 patients in THP group with 18 male patients and 9 female patients;average age with 37.56±8.94 years old;16 patients injured left side and 11 patients injured right side;crush injuries of 10 patients,traffic injuries of 9 patients and sports injuries of 8 patients;Rockwood classification of type III(9 patients),type IV(10 patients)and type V(8 patients).There were 20 patients in TSTHP group with 15 male patients and 5 female patients;average age with 38.95±9.91 years old;13 patients injured left side and 7 patients injured right side;crush injuries of 9 patients,traffic injuries of 8 patients and sports injuries of 3 patients;Rockwood classification of type III(5 patients),type IV(9 patients)and type V(6 patients).The operation time,intraoperative bleeding,postoperative coracoclavicular space,visual analogue scale(VAS)and shoulder joint Constant-Murley score were compared between the two groups.Results The operation time and blood loss of THP group and TSTHP group were 51.07±11.27 min,87.41±15.34 ml and 55.65±8.59 min,90.50±14.32 ml,respectively.The difference was not statistically significant(t=1.52,0.70,all P>0.05).Patients in both groups were followed up for 12 to 14 months after operations,with an average of 12.28 months.Six months after surgery,the coracoclavicular spaces of THP group and TSTHP group were 12.16±0.90 mm and 11.26±0.70 mm,respectively.The difference was statistically significant(t=3.70,P<0.001).Postoperative VAS scores(2 days,3 months,6 months and 12 months)of TSTHP group[1.8±0.77,0.00(0.00,1.00),0.00(0.00,0.00),0.00(0.00,0.00)]were significantly better than THP group[4.22±1.25,2.00(1.00,3.00),1.00(0.00,1.00),0.00(0.00,1.00)].The difference was statistically significant(t=7.65,P<0.001;Z=4.85,P<0.001;Z=3.44,P=0.001;Z=2.96,P=0.003).Postoperative Constant-Murley scores(3 months,6 months and 12 months)of TSTHP group(87.00±5.18,91.25±2.75,92.30±2.74)were significantly better than THP group(76.96±5.21,83.22±3.86,85.22±3.49).The difference was statistically significant(t=6.54,7.93,7.51;P<0.001).The postoperative complication rates of THP group were higher than TSTHP group[70.4%(19/27)vs.5.0%(1/20)].Conclusion In the treatment of acute acromioclavicular dislocation,the clavicular hook plate with extra suture hole can obtain satisfactory clinical effect compared with the THP,and clavicular hook plate with extra suture hole is more conducive to early recovery of shoulder function and reduce postoperative complications.