锁骨钩钢板联合喙肩韧带转位重建喙锁韧带与单纯锁骨钩钢板治疗肩锁关节脱位的疗效比较

Comparison of the efficacy of clavicle hook plate combined with reconstructing coracoclavicular ligament by coracoacromial ligament and clavicle hook plate alone in the treatment of acromioclavicular joint dislocation

目的 探讨锁骨钩钢板联合喙肩韧带转位重建喙锁韧带与单纯锁骨钩钢板治疗RockwoodⅢ、Ⅳ型急性肩锁关节脱位的疗效。方法 30例RockwoodⅢ、Ⅳ型急性肩锁关节脱位患者,根据随机数字表法分为韧带重建组(14例)和单纯钢板组(16例)。韧带重建组行锁骨钩钢板联合喙肩韧带转位重建喙锁韧带治疗,单纯钢板组行单纯锁骨钩钢板治疗。比较两组相关指标[手术时间、切口长度、术中出血量、术后1年视觉模拟评分法(VAS)评分、Constant-Mudey评分],治疗效果,并发症发生情况。结果 两组术中出血量、术后1年VAS评分比较,差异无统计学意义(P>0.05)。韧带重建组切口长度(12.5±0.7)cm、手术时间(83.4±7.5)min长于单纯钢板组的(7.2±0.6)cm、(58.6±9.8)min,Constant-Mudey评分(87.0±1.0)分高于单纯钢板组的(79.0±1.4)分,差异有统计学意义(P<0.05)。韧带重建组优8例,良5例,差1例;单纯钢板组优6例,良4例,差6例。韧带重建组优良率为92.86%,高于单纯钢板组的62.50%,差异有统计学意义(P<0.05)。韧带重建组并发症发生率为0,低于单纯钢板组的31.25%,差异有统计学意义(P<0.05)。结论 锁骨钩钢板联合喙肩韧带转位重建喙锁韧带治疗急性肩锁关节脱位具有固定可靠、疗效确切的优点。

Objective To discuss the efficacy of clavicle hook plate combined with reconstructing coracoclavicular ligament by coracoacromial ligament and clavicle hook plate alone in the treatment of Rockwood type Ⅲ and Ⅳ acromioclavicular joint dislocation.Methods A total of 30 patients with Rockwood Ⅲ and Ⅳacute acromioclavicular joint dislocation were divided into ligament reconstruction group(14 cases) and simple plate group(16 cases) according to the random numerical table.The ligament reconstruction group was treated with clavicle hook plate combined with reconstructing coracoclavicular ligament by coracoacromial 1igament,and the simple plate group was treated with clavicle hook plate alone.The related indicators[operation time,incision length,intraoperative blood loss,visual analogue scale(VAS) score at 1 year postoperatively,Constant-Mudey score],therapeutic effect,and occurrence of complications were compared between the two groups.Results There was no statistically significant difference in intraoperative blood loss and VAS score at 1 year postoperatively(P>0.05).The incision length(12.5±0.7) cm and operation time(83.4±7.5) min of the ligament reconstruction group were longer than(7.2±0.6) cm and(58.6±9.8) min of the simple plate group,and the Constant-Mudey score(87.0±1.0) points was higher than(79.0±1.4) points of the simple plate group.All the differences were statistically significant(P<0.05).8 cases were excellent,5 cases were good and 1 case was poor in the ligament reconstruction group;6 cases were excellent,6 cases were good and 4 cases were poor in the simple plate group.The excellent rate of the ligament reconstruction group was 92.86%,which was higher than 62.50% of the simple plate group,and the difference was statistically significant(P<0.05).The complication rate in the ligament reconstruction group was 0,which was lower than 31.25% in the simple plate group,and the difference was statistically significant(P<0.05).Conclusion Clavicle hook plate combined with reconstructing coracoclavicular ligament by coracoacromial ligament has the advantages of reliable fixation and definite efficacy in the treatment of acute acromioclavicular joint dislocation.