钩钢板结合自体肌腱重建喙锁韧带与单纯钩钢板固定治疗肩锁关节脱位的比较

摘要

背景:钩钢板治疗肩锁关节脱位在临床上较为常见,效果确切,但仍存在较多问题.以自体肌腱重建喙锁韧带联合钩钢板治疗肩锁关节脱位的方法也时有报道,但其与单纯钩钢板治疗效果的对比研究较少.目的:比较应用跖肌腱重建喙锁韧带联合钩钢板与单纯钩钢板固定治疗肩锁关节脱位的临床效果.方法:将38例肩锁关节脱位患者随机分为2组,分别应用跖肌腱"V"形重建喙锁韧带联合钩钢板固定(联合组)与单纯钩钢板固定(单纯钩钢板组).比较2组患者在手术时间、出血量、住院天数、住院平均费用、内固定取出时间、术后12个月肩关节活动度、Constant-Murley功能评分、肩关节复位维持情况及目测类比评分方面的差异.结果与结论:①2组患者均获得12个月以上的随访.联合组患者术后3个月取出钩钢板,单纯钩钢板组患者术后12个月左右取出钩钢板,末次随访2组患者均无脱位发生;②2组患者在住院天数、末次随访肩关节活动度、Constant-Murley评分、术后喙锁间隙距离维持情况及目测类比评分上差异无显著性意义(P > 0.05);③但联合组的手术时间、出血量及住院平均费用均大于单纯钩钢板组(P < 0.05);④结果提示,应用跖肌腱重建喙锁韧带联合钩钢板治疗肩锁关节脱位符合生物力学要求,可早期行内固定取出,但下肢存在切口,术后随访疗效满意;单纯钩钢板固定治疗肩锁关节脱位内固定时间长,效果可,存在再脱位风险(此次入组病例无再脱位).可根据患者病情、需求、经济情况选择合适的修复方式.%BACKGROUND: Hook plate is usual and satisfactory for the treatment of acromioclavicular joint dislocation, but there are still many problems. The comparative analysis is seldom reported between reconstruction of coracoclavicular ligament by autogenous tendon combined with hook plate and simple hook plate. OBJECTIVE: To compare the clinical efficacy of reconstruction of coracoclavicular ligament combined with hook plate and simple hook plate fixation for acromioclavicular joint dislocation. METHODS: A total of 38 patients with acromioclavicular dislocation were randomly divided into two groups. The patients were treated with plantar tendon "V" reconstruction with coracoclavicular ligament combined with hook plate fixation (combination group) and with a simple hook plate fixation (simple hook plate group). We compared the operation time, blood loss, hospitalization days, average hospitalization costs, the time taken for internal fixation, the motion range of shoulder joint at postoperative 12 months, the Constant-Murley function score, the reduction of shoulder joint and the Visual Analogue Scale scores between the two groups. RESULTS AND CONCLUSION: (1) Patients in both groups were followed up for 12 months. In the combination group, the hook plate was removed at postoperative 3 months. In the simple hook plate group, the hook plate was removed at approximately postoperative 12 months. In follow-up, no dislocation appeared in both groups. (2) No significant difference in hospitalization days, motion range of shoulder joint, Constant-Murley function score, the reduction of shoulder joint and the Visual Analogue Scale scores was determined between the two groups (P > 0.05). (3) Operation time was longer; blood loss was more; and average hospitalization costs were higher in the combination group than in the simple hook plate group (P < 0.05). (4) These findings indicate that plantar tendon reconstruction of coracoclavicular ligament combined with hook plate meets biomechanical requirements in the treatment of acromioclavicular joint dislocation. The plate can be removed early using a fixator. The lower extremity has an incision, but the follow-up results are satisfactory. Simple hook plate fixation for acromioclavicular joint dislocation takes a long time, and can obtain average effect, but there is the risk of re-dislocation (this case does not experience re-dislocation). The appropriate treatment can be chosen according to the patient's condition, needs, and economic conditions.