锁扣带袢钛板联合锚钉治疗TossyⅢ型肩锁关节脱位的疗效分析

摘要

目的 比较锁扣带袢钛板(TightRope)重建喙锁韧带联合锚钉修复肩锁韧带与单纯锁骨钩钢板治疗Tossy Ⅲ型肩锁关节脱位的疗效.方法 将72例Tossy Ⅲ型肩锁关节脱位患者按内固定方法分为观察组(采用TightRope+3.5 mm锚钉,35例)和对照组(采用锁骨钩钢板,37例).记录两组手术时间、术中出血量及术后并发症;按Constant-Murley肩关节功能评分评价疗效.结果 患者均获得随访,时间12~18个月.对照组于术后6~11个月拆除内固定.两组手术时间、术中出血量差异无统计学意义(P>0.05).术后3、6个月及末次随访Constant-Murley肩关节功能评分:观察组分别为(88.4 ± 1.7)、(90.0 ± 2.9)、(90.8 ± 2.4)分,对照组分别为(82.1 ± 2.1)、(86.4 ± 1.8)、(86.6 ± 1.7)分,差异均有统计学意义(P<0.05).并发症发生率:观察组为5.71%,对照组为24.32%,两组比较差异有统计学意义(P<0.05).结论 与单纯锁骨钩钢板相比, TightRope重建喙锁韧带联合锚钉修复肩锁韧带治疗Tossy Ⅲ型肩锁关节脱位可以更好地促进肩关节功能恢复,减少肩峰撞击及肩峰下骨溶解等并发症的发生,并能避免二次内固定取出术.%Objective To compare the effect of the locking band loop titanium plate(TightRope) combined with an-chors and the only clavicular hook plate in the treatment of the TossyⅢacromioclavicular joint dislocation. Methods The 72 cases of Tossy Ⅲ acromioclavicular joint dislocation were divided into two groups. There were 35 cases in the observation group (TightRope+3.5 mm anchor), and 37 cases in the control group (claviclular hook plate). The operation time and the intraoperative bleeding volume,the postoperative complications in the two groups were re-corded. The clinical effect was evaluated by Constant-Murley shoulder function score criteria. Results All patients were followed up for 12~18 months. The clavicular hook plate in the control group was removed at 6~11 months af-ter the operation. There were no statistically significant differences in operation time,intraoperative blood loss of two groups(P>0.05). The Constant-Murley scores of shoulder joint at 3,6 months and last follow-up after the opera-tions:In the observation group,the results of the three assessment were 88.4 ± 1.7,90.0 ± 2.9 and 90.8 ± 2.4,re-spectively;and in the control group,the results were 82.1 ± 2.1,86.4 ± 1.8,86.6 ± 1.7, respectively;there were significant differences between the two groups in the three periods(P<0.05).The incidence rate of complications in the observation group was 5.71%, and that was 24.32% in the control group, there was statistically significant difference between the two groups(P<0.05). Conclusions Compared with the only clavicular hook plate,the loc-king with plate titanium plate combined with anchors have the advantages in repairing the acromioclavicular ligament in treatment of Tossy Ⅲ acromioclavicular joint dislocation,which can reduce impingement,acromial end osteolysis and avoid additional internal fixation operation.