两种方法治疗肩锁关节脱位的疗效比较

Effect comparison of two kinds of methods for treatment of acromioclavicular dislocation

目的比较两种方法治疗肩锁关节脱位的疗效。方法将40例肩锁关节脱位患者按照手术方式不同分为对照组(采用单纯钩钢板治疗,22例)和微创组(采用3D打印技术术前塑形钩钢板结合锚钉固定微创治疗,18例)。记录两组并发症发生情况、肩关节活动度。采用Karlsson评分评定肩关节功能,采用Constant-Murley评分评价临床疗效。结果患者均获得随访,时间12~24个月。微创组无再次脱位、内固定失效、肩峰撞击综合征等并发症发生。对照组1例发生钢板周围骨折。肩关节活动度:术后1个月微创组均明显大于对照组(P<0.01);术后3个月两组比较差异均无统计学意义(P>0.05)。术后3个月采用Karlsson评分评定的肩关节功能优良率微创组明显高于对照组(P<0.01)。术后1、3个月Constant-Murley评分微创组均明显高于对照组(P<0.05)。结论与单纯钩钢板相比,采用3D打印技术术前塑形钩钢板结合锚钉固定微创治疗肩锁关节脱位能明显增加钩钢板的匹配性,提高手术质量。多重固定方式相结合既能最大程度降低内固定承受的张力,达到坚强固定,又使患者能早期恢复肩关节功能,减少并发症的发生。

Objective To compare the curative effect between two kinds of methods in the treatment of acromioclavicular joint dislocation.Methods The 40 patients with acromioclavicular dislocation were divided into control group(treated with hook plate alone,22 cases)and minimally invasive group(minimally invasive treatment with preoperative moulding hook plate combined with anchor fixation using 3D printing technique,18 cases),according to operation method.The complications and the range of motion(ROM)of shoulder joint were recorded.The shoulder function was evaluated by Karlsson score,and the clinical efficacy was evaluated with Constant-Murley score.Results All patients were followed up for 12~24 months.In the minimally invasive group,there were no re-dislocation,internal fixation failure,acromion impingement syndrome and other complications.In the control group,1 case had fracture around plate.The ROM of shoulder joint:the minimally invasive group was significantly larger than that in the control group at 1 month after operation(P<0.01);there was no significant difference between the two groups at 3 months postoperation(P>0.05).At 3 months after the operation,the excellent-good rate of shoulder function assessed by Karlsson socring in the minimally invasive group was significantly higher than that in the control group(P<0.01).At the 1,3 months after surgery,the Constant-Murley score was significantly higher in the minimally invasive group than the control group(P<0.05).Conclusions Compared with simple hook plate,minimally invasive treatment with the preoperative moulding hook plate combined with anchor fixation using 3D printing technique are used to treat the acromioclavicular dislocation,which can obviously increase the hook plate matching,improve the quality of operation,and the combination of multiple fixation methods can minimize the tension of internal fixation,and can achieve strong fixation,so that the patients can restore shoulder joint function early,and reduce the incidence of complications.