三种术式治疗RockwoodⅢ型肩锁关节脱位比较  

Comparison of three surgical techniques for Rockwood type III acromioclavicular dislocation

作　　者：陈东旭 李朝旭 王胜涛 彭伟 盛希[1] 陈明洲 CHEN Dong-xu;LI Zhao-xu;WANG Sheng-tao;PENG Wei;SHENG Xi;CHEN Ming-zhou(Nanxishan Hospital of Guangxi Zhuang Autonomous Region,Guilin 541000,China)

机构地区：[1]广西壮族自治区南溪山医院,广西桂林541000

出　　处：《中国矫形外科杂志》2023年第12期1075-1080,共6页Orthopedic Journal of China

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题项目(编号:Z20201232);广西医疗卫生重点培育学科建设项目。

摘　　要：[目的]比较全关节镜下双束三扣板喙锁韧带重建、单束双扣板重建及传统钉钩钢板固定三种手术方法治疗急性RockwoodⅢ型肩锁脱位的临床效果。[方法]回顾性分析2016年10月—2020年12月本院收治49例RockwoodⅢ型肩锁脱位患者的临床资料。依据术前医患沟通结果,15例采用双束重建,17例采用单束重建,17例采用钩板固定。比较三组围手术期、随访及影像结果。[结果]三组均顺利完成手术,无严重并发症。双束组和单束组切口长度、术中出血量、术后住院时间均显著优于钩板组(P<0.05)。随时间推移,三组的疼痛VAS评分均显著减少(P<0.05),术后4、14 d,双束组和单束组VAS评分显著小于钩板组(P<0.05)。所有患者均获随访12个月以上,双束组、单束组恢复完全负重活动时间显著早于钩板组(P<0.05)。随时间推移,三组患者Constant-Murley肩关节功能评分、外展活动度(ROM)、前屈ROM、内外旋ROM均显著增加(P<0.05);术前三组间上述指标的差异均无统计学意义(P>0.05),术后3个月和末次随访时双束组上述指标明显优于单束组和钩板组(P<0.05)。影像方面,与术前相比,术后三组患者肩锁间距(acromioclavicular distance,ACD)和喙锁间距(coracoclavicular distance,CCD)均显著减少(P<0.05)。相应时间点,各组ACD的差异均无统计学意义(P>0.05),但是术后2周和末次随访,双束组、钩板组CCD显著小于单束组(P<0.05)。[结论]本研究表明双束喙锁韧带重建治疗急性RockwoodⅢ型肩锁脱位的临床效果优于单束重建和钩板固定。[Objective]To compare the clinical outcomes of arthroscopic double-bundle coracoclavicular reconstruction with 3 button plates(DB),arthroscopic single-bundle reconstruction with 2 button plates(SB)and traditional open hook plate fixation(HP)for acute Rockwood type III acromioclavicular dislocation.[Methods]A retrospective study was conducted on 49 patients who received surgical treatment for Rockwood type III acromioclavicular dislocation in our hospital from October 2016 to December 2020.According to preopera⁃tive doctor-patient communication,15 patients underwent DB,17 were treated with SB,while the remaining 17 received HP.The periopera⁃tive period,follow-up and imaging data were compared among the three groups.[Results]All the three groups were successfully operated on without serious complications.The DB and SB groups proved significantly superior to the HP group in terms of incision length,intraoper⁃ative blood loss and postoperative hospital stay(P<0.05).The VAS score for pain decreased significantly over time during the early stage in all three groups(P<0.05),which in DB and SB groups were significantly less than that in the HP group 4 and 14 days after surgery(P<0.05).All patients were followed up for more than 12 months,the DB group and SB group resumed full weight-bearing activities significant⁃ly earlier than the HP group(P<0.05).The Constant-Murley scores,abduction range of motion(ROM),forward flexion ROM,and internal-external rotation ROM significantly increased over time in all the three groups(P<0.05).Although there was no significant differences in the abovesaid parameters among the three groups before surgery(P>0.05),the DB group were significantly better in those than the SB group and HP group at 3 months and the latest follow-up(P<0.05).As for imaging,the acromioclavicular distance(ACD)and coracoclavicular dis⁃tance(CCD)significantly reduced postoperatively in all the three groups compared with those preoperatively(P<0.05).There was no signifi⁃cant difference in ACD among all group

关 键 词：肩锁关节脱位 关节镜 喙锁韧带重建 扣板 钩钢板 

分 类 号：R684.7[医药卫生—骨科学]