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作 者:蒙德鹏[1] 欧阳跃平[1] 张伟[1] 刘岩[1] 张竞[1] 侯春林[1] 苟三怀[1]
机构地区:[1]第二军医大学附属长征医院骨科,上海市风阳路415号200003
出 处:《中国矫形外科杂志》2011年第2期99-102,共4页Orthopedic Journal of China
摘 要:[目的]探讨Tossy分类Ⅲ型的肩锁关节损伤手术治疗新方法。[方法]通过回顾性研究,对比两种方法治疗TossyⅢ型肩锁关节脱位患者共48例的疗效。病例按手术方法不同分两组:钛缆经喙突、锁骨固定组(25例),及钩钢板治疗组即对照组(23例);术中对所有病例均不过多的暴露和修复损伤的喙锁韧带。所有病例12~19个月后取出内植物,对所有患者的临床症状、体征和影像学表现进行随访,对结果进行统计学分析。[结果]平均随访时间为3.5年,钛缆经喙突、锁骨固定组:Constant-Murley评分平均(93.4±8.3)分,Karlsson评分优良率96%,并发症发生率4%;钩钢板固定组:Constant-Murley评分平均(88.1±9.5)分,Karlsson评分优良率87%,并发症发生率13%。经方差齐性检验和独立样本t检验,两组Constant-Murley评分有明显统计学差异,P〈0.05。[结论]钛缆经喙突-锁骨固定技术是治疗肩锁关节脱位的一种符合生理学原理、简便和效果良好的方法。不过多的暴露和修复喙锁韧带对新鲜损伤病例愈合无明显影响却能减少损伤。[Objective]To investigate a novel technique in the treatment of Tossy type Ⅲ acromioclavicular joint dislocation.[Method]Forty-eight cases were divided into two major groups according to two different procedures.In the group of cable fixation(n=25),a cerclage was applied with the tightened titanium cable around the fundus of coracoid process and the vertical clavicle after satisfactory reduction.The group of hook plate(n=23) was set as control group.No especial exposure or repair of coracoclavicular ligament and coracoacromial ligament was performed in all cases.An implant removal was managed 12-19 months later.The effects were compared statistically based on Constant-Murley score system,Karlsson assessment and complications incidence.[Result] According to mean follows up of 3.5 years,an average score of 93.4±8.3 points(Constant-Murley),good to excellent result of 96 %(Karlsson) and complication incidence of 4 % were observed in group of cable fixation while 88.1±9.5(Constant-Murley),87%(Karlsson) and 13%(complication incidence) in group of hook plate.With application of independent samples t test of the Constant-Murley score,statistical difference was found between these two groups.[Conclusion]This novel technique of reduction and fixation between clavicle and coracoid with titanium cable is a good alternative in the treatment of acromioclavicular joint dislocation for its proper biomechanism,simplicity and good clinical results.Avoiding further exposure and repair of the coracoclavicular ligament,this method leads to a good outcome in the fresh cases for a less invasion.
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