原止点解剖重建喙锁韧带与锁骨钩钢板固定治疗肩锁关节脱位的疗效比较

Comparison of therapeutic effects between anatomical reconstruction of the coracoclavicular ligament at the original insertion point and clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation

目的比较原止点解剖重建喙锁韧带与锁骨钩钢板固定治疗肩锁关节脱位的临床疗效。方法回顾性分析2015年6月至2021年1月在南京医科大学第一附属医院骨科接受手术治疗的单侧肩锁关节脱位患者67例,根据手术方式分为重建组(采用原止点解剖重建喙锁韧带)和钩钢板组(采用锁骨钩钢板固定喙锁韧带)。重建组37例,男26例、女11例,年龄(47.2±9.6)岁(范围18~65岁),左侧13例、右侧24例,运动损伤8例、跌倒摔伤14例、交通事故伤11例、殴打致伤4例,受伤至手术时间(8.3±2.3)d。钩钢板组30例,男24例、女6例,年龄(47.4±9.7)岁(范围18~67岁),左侧12例、右侧18例,运动损伤7例、跌倒摔伤11例、交通事故伤9例、殴打致伤3例,受伤至手术时间为(7.9±2.6)d。比较两组患者的手术时间、切口长度、术中出血量、住院时间、术后喙锁间距分离比、肩锁间距分离比及术后并发症。采用Constant-Murley功能评分及视觉模拟评分(visual analogue scale,VAS)评估患者肩关节功能及疼痛程度。结果两组患者均获得随访,重建组随访时间为(12.3±0.4)个月,钩钢板组为(12.2±0.5)个月。重建组的手术时间[(105.8±10.0)min]、切口长度[12.0(11.0,13.0)cm]和住院时间[(6.8±2.1)d]均长于钩钢板组[(48.3±4.9)min、10.0(10.0,11.0)cm和(5.5±2.7)d],而术中出血量[(75.1±3.9)ml]小于钩钢板组[(90.3±6.3)ml],差异有统计学意义(P<0.05)。重建组术后3 d、3个月和12个月的VAS[(4.0(3.0,5.0)、3.0(3.0,3.0)、2.0(1.0,2.0)分]、Constant-Murley评分[(65.4±4.5)、(84.9±2.5)、(90.1±2.5)分]均优于钩钢板组[5.0(4.0,5.0)、4.0(4.0,4.0)、3.0(3.0,4.0)分和(56.9±3.5)、(79.6±4.0)、(86.8±2.4)分],差异有统计学意义(P<0.05)。末次随访时,重建组喙锁间距分离比(0.12±0.08)小于钩钢板组的0.22±0.15,差异有统计学意义(t=3.25,P=0.002);而肩锁间距分离比[0.16(0.05,0.25)和0.16(0.04,0.40)]的差异无统计学意义(Z=-0.52,P=0.605)。术后钩钢板组6例出现肩关节异物感、2例出现肩锁关节再脱位(均为RockwoodⅢ型),重建组无一例发生肩锁关节再脱位。结论与锁骨钩钢板固定比较,原止点解剖重建喙锁韧带治疗肩锁关节脱位可更快减轻患肩关节疼痛,术后关节功能恢复好、并发症少。

Objective To compare the clinical efficacy of anatomical reconstruction of coracoclavicular ligament at the original insertion point and clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation.MethodsRetrospective analysis was made on the data of 67 patients with acromioclavicular joint dislocation who received surgical treatment in the Department of Orthopaedics of the First Affiliated Hospital of Nanjing Medical University from June 2015 to January 2021.According to the surgical method,they were divided into reconstruction group(using the technique of anatomical reconstruction of coracoclavicular ligament at the original insertion point)and hook plate group(using the clavicular hook plate).There were 37 cases in the reconstruction group,including 26 males and 11 females,aged 47.2±9.6 years(range,18-65 years),13 cases on the left and 24 cases on the right.Among the 37 patients,8 were sports injuries,14 were falls,11 were traffic accidents,and 4 were external force injuries.The average time from injury to surgery was 8.3±2.3 days.There were 30 cases in the hook plate group,including 24 males and 6 females,aged 47.4±9.7 years(range,18-67 years),12 cases on the left and 18 cases on the right.Among the 30 patients,7 were sports injuries,11 were falls,9 were traffic accidents,and 3 were external force injuries.The average time from injury to surgery was 7.9±2.6 days.The surgical time,incision length,intraoperative bleeding,hospital stay,postoperative coracoclavicular separation ratio,and postoperative complications were compared between the two groups.Constant-Murley score and visual analog scale(VAS)were used to assess the shoulder joint function and pain degree of patients.ResultsBoth groups of patients were followed up,with a follow-up time of 12.3±0.4 months for the reconstruction group and 12.2±0.5 months for the hook plate group.The operation time(105.8±10.0 min),incision length[12.0(11.0,13.0)cm]and hospitalization time(6.8±2.1 d)in the reconstruction group were longer than those in the hook plate group[48.3±4.9 min,10.0(10.0,11.0)cm,and 5.5±2.7 d],while the intraoperative blood loss(75.1±3.9 ml)was less than that in the hook plate group(90.3±6.3 ml),the differences were statistically significant(P<0.05).The VAS[4.0(3.0,5.0),3.0(3.0,3.0),2.0(1.0,2.0)points]and Constant-Murley score(65.4±4.5,84.9±2.5,90.1±2.5 points)of the reconstruction group at 3 days,3 months,and 12 months after surgery were better than those of the hook plate group[5.0(4.0,5.0),4.0(4.0,4.0),3.0(3.0,4.0)and 56.9±3.5,79.6±4.0,86.8±2.4 points],the difference was statistically significant(P<0.05).At the last follow-up,there was a statistically significant difference in the separation ratio of coracoclavicular distance between the reconstruction group(0.12±0.08)and the hook plate group 0.22±0.15(t=3.25,P=0.002).There was no significant difference(Z=-0.52,P=0.605)in the separation ratio of acromioclavicular distance[0.16(0.05,0.25)and 0.16(0.04,0.40)].In the hook plate group,6 cases had shoulder joint foreign body sensation and 2 cases had acromioclavicular joint redislocation(both Rockwood type III).Because the shoulder joint function did not affect their daily life,neither patient underwent secondary surgery.And no case of acromioclavicular joint redislocation occurred in the reconstruction group.ConclusionCompared with the clavicular hook plate fixation,anatomic reconstruction of coracoclavicular ligament at the original insertion point in the treatment of acromioclavicular joint dislocation can reduce the pain of the shoulder joint earlier,which has the characteristics of small trauma,good effect,and reduces the steps of internal fixation removal,and has good clinical curative effect.