肩锁韧带缝线稳定联合锁骨钩钢板固定与袢钢板韧带全修复治疗肩锁关节脱位的疗效比较

Comparation of clinical effect of acromioclavicular joint dislocation with suture stabilization technique of acromioclavicular ligament combined with clavicular hook plate fixation and total ligament repair technique with loop plates

目的对比肩锁韧带缝线稳定技术联合锁骨钩钢板固定和袢钢板韧带全修复技术治疗肩锁关节脱位的临床疗效。方法回顾性分析于2022年1月至2023年6月南京医科大学第一附属医院骨科收治的肩锁关节脱位59例患者病历资料,分为缝线组和袢钢板组。缝线组31例患者,其中男20例,女11例;年龄(42.3±6.9)岁;运用缝线稳定技术行肩锁韧带修复并联合锁骨钩钢板固定进行治疗。袢钢板组28例患者,其中男18例,女10例;年龄(41.8±7.3)岁;运用韧带全修复理念,使用Endobutton袢钢板对喙锁韧带进行解剖学双束重建和肩锁韧带进行解剖学单束重建进行治疗。比较两组的手术一般情况、住院情况、并发症、复位情况、影像学参数和肩关节功能Constant-Murley评分等指标。结果入组患者均获得随访,随访时间6~15(平均9.6)个月。缝线组在手术时间、切口长度、术中出血、住院时间、住院费用等指标比较上明显优于袢钢板组(P<0.05)。缝线组在复位质量比较上明显优于袢钢板组(P<0.05)。在肩关节功能评分比较上,两组术前和术后6个月比较时差异无统计学意义(P>0.05),但缝线组在取出内固定后的末次随访时Constant-Murley评分明显优于袢钢板组(P<0.05)。缝线、袢钢板两组在并发症和影像学参数比较上差异无统计学意义(P>0.05)。结论肩锁韧带缝线稳定技术联合锁骨钩钢板固定的治疗方法,将弹性固定和刚性固定相结合,提高了肩锁关节各方向稳定性,显著降低了肩锁关节周围的应力负荷,降低了手术并发症,有利于肩关节功能恢复,符合卫生经济学,建议在临床推广和使用。

Objective To compare the clinical effect of suture stabilization technique of acromioclavicular ligament combined with clavicular hook plate fixation and total ligament repair technique with loop plates in the treatment of acromioclavicular joint dislocation.Methods From January 2022 to June 2023,59 patients with acromioclavicular joint dislocation according to inclusion-exclusion criteria were admitted to the Department of Orthopedics Surgery in the First Affiliated Hospital of Nanjing Medical University and were retrospectively analyzed as well as divided into stitches group and Endobutton group.31 cases were in stitches group,with an average age of 42.3±6.9 years old,including 20 males and 11 females,treated with suture stabilization technique of acromioclavicular ligament combined with clavicular hook plate fixation.28 cases were in Endobutton group,with an average age of 41.8±7.3 years old,including 18 males and 10 females,treated with total ligament repair technique with loop plates,to be specifically,by anatomical double-bundle reconstruction of coracoclavicular ligament and anatomical single-bundle reconstruction of acromioclavicular ligament with Endobutton loop plates.The general situation of operation,hospitalization situation,complications,reduction quality,imaging parameters and Constant-Murley score of shoulder joint function were evaluated between the two groups.Results All patients were followed up for 6-15 months with average of 9.6 months.Compared with Endobutton group,stitches group had obvious advantages in operation time,incision length,intraoperative bleeding,hospitalization time and hospitalization expenses,and the differences were statistically significant(P<0.05).The reduction quality of stitches group was significantly better than that of Endobutton group,and the difference was statistically significant(P<0.05).On the comparison of shoulder joint function score,there were no significant statistical differences between the two groups before operation and 6 months post-operation(P>0.05),however the Constant-Murley score in stitches group was significantly better than that in Endobutton group at the last follow-up after removing internal fixation,and the difference was statistically significant(P<0.05).There were no significant differences in complications and imaging parameters between the two groups(P>0.05).Conclusion The suture stabilization technique of acromioclavicular ligament combined with clavicular hook plate fixation can improve the stability of acromioclavicular joint in all directions,significantly reduce the stress load around acromioclavicular joint and the surgical complications,benefit to the recovery of shoulder joint function and conform to health economics.This treatment method is suggested to be popularized and used in clinic.