双纽扣钢板联合加强锚钉治疗肩锁关节脱位

Analysis of the effect of double button plate combined with strengthened anchor in the treatment of acromioclavicular dislocation

目的:探讨双纽扣钢板联合加强锚钉技术与锁骨钩钢板内固定治疗完全性肩锁关节脱位的疗效及预后。方法:选取2017年7月至2020年9月收治的手术治疗肩锁关节脱位患者42例为研究对象,分为观察组(21例)和对照组(21例)。观察组中,男14例,女7例;年龄21~63(45.05±8.70)岁;对照组中,男16例,女5例;年龄25~68(45.00±9.44)岁。观察组行双纽扣钢板联合加强锚钉技术治疗,对照组行锁骨钩钢板内固定术治疗。比较两组患者手术时间、术中出血量、术后住院时间,术前及术后1、3、6个月肩关节疼痛视觉模拟评分(visual analogue scale,VAS),肩关节功能Constant-Murley评分以及术后并发症发生情况。结果:两组术中出血量及术后住院时间比较,差异无统计学意义(P>0.05);双纽扣钢板联合加强锚钉技术组手术时间(65.24±5.36)min,较锁骨钩钢板组(48.81±4.72)min长(P<0.05)。肩关节功能及疼痛程度测定显示,术前两组差异无统计学意义(P>0.05);术后1、3、6个月,观察组Constant-Murley评分分别为(73.29±2.15)、(85.43±1.47)、(93.86±1.24)分,与对照组比较差异有统计学意义;VAS评分为(2.76±0.62)、(1.71±0.64)、(0.57±0.51)分,与对照组比较,差异有统计学意义(P<0.05)。观察组术后1例肩部疼痛;对照组术后5例肩部疼痛,2例肩关节活动受限,1例肩峰下骨质吸收,两组均未出现复位丢失。结论:双纽扣钢板联合加强锚钉治疗完全性肩锁关节脱位能够获得良好的临床效果,无须取出内固定,患者肩关节功能恢复情况及疼痛改善情况优于锁骨钩钢板内固定术,更值得临床推广。

Objective:To evaluate the efficacy and prognosis of double button plate combined with strengthened anchor technique and clavicular hook plate internal fixation for complete acromioclavicular joint dislocation.Methods:From July 2017 to September 2020,a total of 42 patients with acromioclavicular joint dislocation treated by surgery were choosen as study objects and divided into observation group(21 cases)and control group(21 cases).In the observation group,there were 14 males and 7 females,aged 21 to 63 years old,with an average of(45.05±8.70)years old.In the control group,there were 16 males and 5 females,aged 25 to 68 years old,with an average of(45.00±9.44)years old.The patients in the observation group were treated with double button plate combined with strengthened anchor technique,whereas those in the control group received clavicular hook plate internal fixation.The two groups were compared in terms of operating time,intraoperative blood loss,postoperative hospital stay,shoulder pain(visual analogue scale,VAS)score,shoulder function Constant-Murley score and postoperative complications.Results:There was no significant difference between the two groups in intraoperative blood loss or postoperative hospital stay(P>0.05).The operating time of double button plate combined with strengthened anchor technique group(65.24±5.36)min was significantly longer than that of the clavicular hook plate group(48.81±4.72)min,and the difference was statistically significant(P<0.05).There was no significant difference in shoulder function or pain degree between the two groups before operation(P>0.05).After 1 month,3 months and 6 months,the Constant-Murley score of the observation group was 73.29±2.15,85.43±1.47,93.86±1.24 separately,which were significantly higher than those of the control group;and the VAS score was 2.76±0.62,1.71±0.64,0.57±0.51 separately,which were significantly lower than those of the control group(P<0.05).One instance of shoulder discomfort was found in the observation group,while 5 cases of shoulder pain,2 cases of restricted shoulder mobility,and 1 case of subacromial bone absorption were found in the control group.In both group,there was no loss of reduction.Conclusion:In the treatment of complete acromioclavicular joint dislocation double button plate combined with strengthened anchor technique achieves favorable clinical result.Internal fixation does not need to be removed.The recovery of shoulder joint function and pain relief are superior than clavicular hook plate internal fixation,which is more worthy of clinical promotion.