钩钢板治疗肩锁关节脱位术后肩峰下撞击综合征与第二肩关节间隙的关系

摘要

目的 探讨锁骨钩钢板治疗肩锁关节脱位(TossyⅢ型)术后发生肩峰下撞击综合征(subacromial impingement syndrome,SIS)与第二肩关节间隙的关系.方法 2005年7月至2008年10月,肩锁关节脱位(TossyⅢ)患者63例,男48例,女15例;年龄21～53岁,平均33.6岁;受伤至手术时间3～7 d,平均4d.所有患者均行切开复位锁骨钩钢板内固定.采用改良野田氏位摄片,并在X线片上测量第二肩关节间隙,即肩峰-肱骨头间距(acromio-humeral interval,AHI)和钢板-肱骨头间距(plate-humeral interval,PHI).术后根据Karlsson疗效标准评价肩关节功能.结果 术后根据有无典型肩痛分为两组,其中有SIS患者14例,无SIS患者49例.所有患者均获得随访,随访时间6～15个月,平均12.2个月.SIS组AHI为5.2～11.4mm,平均(8.5±2.1)mm;无SIS组AHI为6.4～13.7 mm,平均(9.7±2.6)mm,两组比较差异有统计学意义(t=4.89,P＜0.05).SIS组AHI与SIS有相关性(F=7.14,P＜0.05).SIS组PHI为2.7～10.2mm,平均(6.1±2.8)mm;无SIS组PHI为3.1～10.8mm,平均(6.8±2.4)mm,两组比较差异无统计学意义(t=1.34,P=0.243).术后3个月,SIS组患者拆除钢板后Karlsson疗效评价:优11例,良3例,优良率为100%.结论 锁骨钩钢板术后出现SIS与第二肩关节间隙有相关性,第二肩关节间隙较小的患者术后可能出现SIS.%Objective To analyze the effect of acromio-humeral interval on the occurrence of subacromial impingement syndrome (SIS) after the clinical application of clavicular hook plate in acromioclavicular joint dislocation (Tossy Ⅲ). Methods From July 2005 to October 2008, 63 cases of acromioclavicular joint dislocation (Tossy Ⅲ) were treated with clavicular hook plate. There were 48 males and 15 females with an average age of 33.6 years (range, 21-53 years). The relationship of the acromio-humeral interval (AHI)were analysed between the two groups by X-ray measurement. The AHI and plate-humeral interval (PHI)were measured on X-ray film to detect difference between the two groups. Results After the operation, all t he 63 cases were divided into two groups according the occurrence of SIS. There were 14 cases in the group of SIS and 49 cases in the group without SIS. The mean follow-up was 12.2 (average, 6-15) months.The average AHI of was (8.5±2.1) mm and (9.7±2.6) mm in the group of SIS and the group without SIS respectively. The difference between the two groups was statistically significant. The average PHI of the group of SIS and the group without SIS was (6.1±2.8) mm and (6.8±2.4) mm respectively. There was no difference between the two groups. After removal of the clavicular hook plate, the clinical sign disappeared in the group of SIS. According the Karlsson scoring system, the excellent and good rate of the shoulder function was 100%. Conclusion The occurrence of SIS after the clinical application of clavicular hook plate has related to the width of the subacromial interval. The syndrome could be treated by the removal of clavicular hook plate.