带线锚钉重建喙锁韧带、肩锁韧带与锁骨钩钢板固定治疗肩锁关节脱位的疗效比较  

Comparisons of therapeutic effects between hook plate fixation and coracoclavicular ligament and acromioclavicular ligament reconstruction with suture anchor for acromioclavicular dislocation

作　　者：赖震[1] 李明明 李燕文[1] 杨晓东[1] 吴峰[1] 谢庭裕 LAI Zhen;LI Mingming;LI Yanwen;YANG Xiaodong;WU Feng;XIE Tingyu(Department of Orthopaedics,Huadu District People's Hospital of Guangzhou,Guangzhou,Guangdong 510800,China)

机构地区：[1]广州市花都区人民医院骨科,510800 [2]广州市花都区狮岭镇卫生院,510800

出　　处：《中国骨科临床与基础研究杂志》2024年第2期110-114,共5页Chinese Journal of Orthopaedic Clinical and Basic Research

基　　金：广州市花都区医疗卫生一般科研专项项目(21-HDWS-002)。

摘　　要：目的比较带线锚钉重建喙锁韧带、肩锁韧带和锁骨钩钢板内固定两种术式治疗肩锁关节脱位的短期疗效差异。方法回顾性分析2018年1月至2023年6月广州市花都区人民医院手术治疗的59例RockwoodⅢ~Ⅴ型肩锁关节脱位患者的临床资料。患者根据手术方式的不同分入韧带重建组(使用带线锚钉重建喙锁韧带及肩锁韧带,n=27)和钢板内固定组(使用锁骨钩钢板固定,n=32)。比较两组患者的手术时间、术中出血量和住院时间,记录随访期间肩关节活动范围(ROM)、视觉模拟量表(VAS)评分和Constant-Merly评分,测量末次随访喙锁间距。结果患者获得6~26个月(平均11.3个月)随访。韧带重建组手术时间长于钢板内固定组(P<0.05);两组患者术中出血量、住院时间以及术后1、3个月VAS评分相近(P>0.05);韧带重建组患者术后6个月VAS评分,末次随访Constant-Merly总评分及肩关节活动范围、日常活动、疼痛程度3个分项评分均优于钢板内固定组(P<0.05),比较两组末次随访肩关节力量分项评分和喙锁间距,差异无统计学意义(P>0.05)。结论对于肩锁关节脱位患者,应用缝合锚钉重建喙锁韧带、肩锁韧带与锁骨钩钢板内固定两种术式均能获得良好疗效,其中韧带重建术式尽管手术时间相对较长,但在改善肩关节功能、提高生活质量等方面具有一定优势,同时可避免二次手术。Objective To compare the difference of short-term effects between coracoclavicular(CC)ligament and acromioclavicular(AC)ligament reconstruction and clavicular hook plate internal fixation in the treatment of acromioclavicular dislocation(ACD).Methods Clinical data of 59 patients who suffered from ACD with Rockwood typeⅢto type V and treated surgically in Huadu District People's Hospital of Guangzhou from January 2018 to June 2023 were analyzed retrospectively.According to different surgical methods,patients were divided into ligament reconstruction group(CC and AC ligament reconstruction with suture anchor,n=27)and plate internal fixation group(fixed with clavicular hook plate,n=32).Operation time,intraoperative blood loss and hospital stay were compared between the two groups.The shoulder range of motion(ROM),visual analogue scale(VAS)score and Constant-Merly score during the follow-up period were recorded,and the CC distance at the last follow-up was measured. Results Patients were followed up for 6 to 26 months (mean 11.3 months). Operation time in plate internal fixation group was less than that in ligament reconstruction group (P <0.05), while intraoperative blood loss, hospital stay and VAS score at 1, 3 months postoperatively were similar in the two groups (P >0.05). In ligament reconstruction group, VAS score at 6 months postoperatively, as well as total Constant-Merly score and 3 items of scores of ROM, daily activity and pain degree of shoulder at the latest follow-up were better than those in plate internal fixation group (P <0.05), while there were no statistical differences in shoulder strength item score and CC distance at the latest follow-up between the two groups (P < 0.05). Conclusions For patients with ACD, good results could be obtained by using two procedures of suture anchor with reconstruction of CC and AC ligament and clavicular hook plate fixation. Ligament reconstruction has certain advantages in improving shoulder joint function and quality of life, and avoiding secondary operation al

关 键 词：肩脱位 肩锁关节 修复外科手术 缝合锚钉 喙锁韧带 肩锁韧带 锁骨钩钢板 

分 类 号：R684.71[医药卫生—骨科学] R687.32[医药卫生—外科学]