悬吊钛板双束重建喙锁韧带治疗Ⅲ型肩锁关节脱位  

Double-bundle reconstruction of coracoclavicular ligament with Rigidloop for type Ⅲ acromioclavicular dislocation

作　　者：罗立立[1] 高益[1] 沈鹏飞[1] 周祺[1] 裴杰 瞿玉兴[1] LUO Li-li;GAO Yi;SHEN Peng-fei;ZHOU Qi;PEI Jie;QU Yu-xing(Changzhou Hospital of Traditional Chinese Medicine,Nanjing University of Chinese Medicine,Changzhou 213000,China)

机构地区：[1]南京中医药大学附属常州市中医医院,江苏常州213000

出　　处：《中国矫形外科杂志》2023年第20期1825-1830,共6页Orthopedic Journal of China

基　　金：南京中医药大学自然科学基金项目(编号:XZR2020041);常州市卫健委重大科技项目(编号:ZD202026)。

摘　　要：[目的]探讨Rigidloop悬吊钛板双束重建喙锁韧带治疗RockwoodⅢ型肩锁关节脱位的效果。[方法]回顾性研究本院在2019年6月-2020年6月因RockwoodⅢ型肩锁关节脱位接受手术治疗的48例患者的临床资料,按术前医患沟通结果,22例采用钩钢板固定,26例采用Rigidloop重建喙锁韧带。比较两组围手术期、随访和影像指标。[结果]两组患者均顺利完成手术,两组手术时间的差异无统计学意义(P>0.05)。重建组切口总长度[(4.3±0.5)cm vs(7.0±0.8)cm,P<0.05]、术中失血量[(62.0±15.8)ml vs(97.1±26.5)ml,P<0.05]、住院时间[(11.1±2.3)d vs(14.3±2.9)d,P<0.05]均显著优于钩板组。随术后早期时间推移,VAS评分均显著降低(P<0.05),CRP显著增加(P<0.05),但IL-6无显著变化(P>0.05);相应时间点,重建组的早期VAS评分、CRP、IL-6水平均显著优于钩板组(P<0.05)。所有患者术后平均随访(22.2±2.5)个月,两组患者恢复完全负重活动时间的差异无统计学意义(P>0.05)。随时间推移,两组患者的UCLA肩关节功能评分、肩关节外展上举、前屈上举、内外旋ROM均显著增加(P<0.05)。末次随访时,重建组的UCLA评分[(32.5±3.7)vs(29.1±3.1),P=0.002]、外展上举ROM[(151.4±10.4)°vs(135.6±12.4)°,P<0.001]、内旋ROM[(62.9±13.0)°vs(52.1±11.4)°,P=0.004]和外旋ROM[(66.6±9.4)°vs(57.0±9.4)°,P<0.001]均显著优于钩板组。影像方面,术后3个月及末次随访时两组患者的喙锁距离(coracoclavicular distance,CC)和肩锁距离(acromioclavicular distance,AC)均较术前显著减小(P<0.05)。相应时间点,两组间CC和AC的差异均无统计学意义(P>0.05)。[结论]相比于钩板组治疗RockwoodⅢ型肩锁关节脱位,重建组具有创伤小、术后恢复快、术后疼痛轻微、术后炎症水平低等优点,还可有效改善患者肩关节功能和肩关节活动度,提升肩锁关节复位效果。[Objective]To evaluated the clinical outcomes of double-bundle reconstruction of coracoclavicular ligament with Rigid-loop for type Ⅲ acromioclavicular dislocation.[Methods]A retrospective study was conducted on 48 patients who received surgical treat-ment for Rockwood Ⅲ acromioclavicular dislocation in our hospital from June 2019 to June 2020.According to preoperative doctor-patient communication,22 patients received hook plate fixation,while the remaining 26 patients underwent double-bundle reconstruction of cora-coclavicular ligament with Rigidloop.Perioperative period,follow-up and imaging data were compared between the two groups.[Results]All patients in both groups had corresponding surgical procedures performed successfully,without a significant difference in the operation time between the two groups(P>0.05).The reconstructed group proved significantly superior to the hook plate group in terms of the total length of incision[(4.3±0.5)cm vs(7.0±0.8)cm,P<0.05],intraoperative blood loss[(62.0±15.8)ml vs(97.1±26.5)ml,P<0.05]and hospital stay[(11.1±2.3)days vs(14.3±2.9)days,P<0.05].The VAS scores significantly decreased in both groups(P<0.05),the CRP was significant-ly increased(P<0.05),whereas the IL-6 remained unchanged in both group over time in the early stage postoperatively(P>0.05),which in the reconstructed group were significantly better than the hook plate group at all time point accordingly during the early stage(P<0.05).All patients were followed up for(22.2±2.5)months on an average,with no a significant difference in the time to return to full weight-bearing activities between the two groups(P>0.05).The UCLA score,shoulder abduction-lifting,forward flexion-lifting,internal rotation and exter-nal rotation range of motions(ROMs)were significantly increased in both groups over time(P<0.05).At the latest follow-up the reconstruct-ed group was significantly superior to the hook plate group regarding UCLA score[(32.5±3.7)vs(29.1±3.1),P=0.002],abduction-lifting ROM[(151.4±10.4)°vs(135.6±12.

关 键 词：肩锁关节脱位 锁骨钩钢板 Rigidloop悬吊钛板 双束重建喙锁韧带 

分 类 号：R684.7[医药卫生—骨科学]