改良袢钢板Nice结固定急性肩锁关节脱位

Modified Nice knots and loop plate for acute acromioclavicular dislocation

[目的]比较改良袢钢板Nice结与钩钢板固定肩锁关节脱位的临床疗效。[方法]回顾性分析2017年1月—2020年1月本院收治的Rockwood III、V型肩锁关节脱位34例患者的临床资料,依据术前医患沟通结果,18例行改良袢钢板Nice结固定(袢板组),16例行锁骨钩钢板固定(钩板组)。比较两组的围手术期、随访和影像学资料。[结果]两组患者均顺利完成手术,无神经、血管损伤等并发症,两组手术时间、术中出血量、住院时间、切口长度、切口愈合等级的差异均无统计学意义(P>0.05),随访平均(16.4±3.6)个月。与术前相比,术后9个月两组疼痛VAS、Constant及ASES评分均显著改善(P<0.05)。术前两组上述指标的差异均无统计学意义(P>0.05),术后9个月袢板组的VAS评分[(1.1±0.8) vs (2.5±1.2),P<0.001]、Constant评分[(87.1±2.7) vs (75.7±2.8),P<0.001]和ASES评分[(83.8±3.7) vs (77.8±5.2),P<0.001]均显著优于钩板组。影像方面,与术前相比,末次随访时两组的肩锁间距(acromioclavicular distance,ACD)和喙锁间距(coracoclavicular distance,CCD)均显著减少(P<0.05)。相应时间点,两组CCD和ACD的差异均无统计学意义(P>0.05)。[结论]改良袢钢板Nice结固定肩锁关节脱位的临床疗效优于钩板固定。

[Objective] To compare the clinical efficacy of modified Nice knots and loop plate(MNLP) versus hook plate(HP) for fixation of acromioclavicular dislocation.[Methods] A retrospective study was done on 34 patients who received surgical treatment for Rockwood type III or V acromioclavicular dislocation in our hospitals from January 2017 to January 2020.According to preoperative doctor-patient communication,18 patients underwent open reduction and fixation with MNLP,while the remaining 16 patients were with HP.The perioperative period,follow-up and imaging data of the two groups were compared.[Results] All patients in both groups had corresponding surgical procedures performed without nerve,vascular injury and other complications,without significant differences in terms of operation time,intraoperative blood loss,hospital stay,incision length,incision healing grade between the two groups(P>0.05),and followed up for(16.4±3.6) months on a mean.Compared with those preoperatively,the pain VAS,Constant and ASES scores in both groups were significantly improved 9 months after operation(P<0.05).There was no significant difference in abovementioned items between the two groups before operation(P>0.05),the MNLP group proved significantly superior to the HP group in terms of VAS score [(1.1±0.8) vs(2.5±1.2),P<0.001],Constant score [(87.1±2.7) vs(75.7±2.8),P<0.001] and ASES scores [(83.8±3.7) vs(77.8±5.2),P<0.001] 9 months postoperatively.Regarding to imaging,the acromioclavicular distance(ACD) and coracoclavicular distance(CCD) in both groups decreased significantly at the last follow-up compared with those preoperatively(P<0.05),whereas which were not significantly different between the two groups at any time points accordingly(P>0.05).[Conclusion] The modified Nice knots and loop plate do achieve considerably better clinical consequences over the hook plate fixation for acute acromioclavicular dislocation.