双微创切口双骨性通道带袢钛板联合Dog-Bone钛板固定治疗急性Rockwood Ⅲ型肩锁关节脱位的疗效分析  

Fixation through dual minimally invasive incisions and dual osseous channels with a loop titanium plate combined with a Dog-Bone titanium plate for acute Rockwood Ⅲ acromioclavicular dislocation

作　　者：李浩 成永忠[2] 田慧超 闫军 刘玉铎 张健[1] 贺新兵 韩立仁 Li Hao;Cheng Yongzhong;Tian Huichao;Yan Jun;Liu Yuduo;Zhang Jian;He Xinbing;Han Liren(Department of Orthopedics,Beijing Jishuitan Hospital Liaocheng Hospital/Liaocheng People's Hospital,Liaocheng 252000,China;Department of Traumatology,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China)

机构地区：[1]北京积水潭医院聊城医院/聊城市人民医院骨科,聊城252000 [2]中国中医科学院望京医院创伤科,北京100102

出　　处：《中华创伤骨科杂志》2024年第10期878-884,共7页Chinese Journal of Orthopaedic Trauma

基　　金：山东省2021年度博士后创新项目(202103066)

摘　　要：目的通过与切开复位锁骨钩钢板固定比较, 探讨双微创切口双骨性通道带袢钛板联合Dog-Bone钛板固定治疗急性Rockwood Ⅲ型肩锁关节脱位的疗效。方法回顾性分析2019年2月至2022年5月聊城市人民医院创伤骨科收治的60例急性Rockwood Ⅲ型肩锁关节脱位的患者资料。男35例, 女25例;左侧34例, 右侧26例;年龄(43.2±8.0)岁。根据手术方法不同分为2组:双钛板组32例(采用双微创切口双骨性通道带袢钛板联合Dog-Bone钛板固定)和钩钢板组28例(采用切开复位锁骨钩钢板固定)。受伤至手术时间为(2.1±1.3)d。记录并比较两组患者切口长度、手术时间、术中出血量、术前和末次随访时的VAS评分、Constant-Murley肩关节功能评分及患侧的喙锁间距, 观察有无感染、内固定松动或继发性骨折等并发症。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05), 具有可比性。所有患者术后获(11.2±2.1)个月随访。双钛板组患者的切口长度[(3.5±0.3)cm]显著短于钩钢板组[(6.2±0.7)cm], 术中出血量[(45.3±7.5)mL]显著少于钩钢板组[(64.1±6.2)mL], 差异均有统计学意义(P<0.05)。但两组患者的手术时间比较差异无统计学意义(P>0.05)。末次随访时双钛板组患者的VAS评分[0.5(0,1.0)分]、Constant-Murley肩关节功能评分[(95.1±2.1)分]均显著优于钩钢板组[0.8(0,1.0)、(86.0±4.4)分], 差异均有统计学意义(P<0.05)。但两组患者的患侧喙锁间距比较差异无统计学意义(P>0.05)。所有患者肩锁关节复位及固定良好, 除双钛板组有1例患者窦道形成外, 其余患者均无手术相关并发症发生。结论与切开复位锁骨钩钢板固定比较, 双微创切口双骨性通道带袢钛板联合Dog-Bone钛板固定治疗急性Rockwood Ⅲ型肩锁关节脱位肩锁关节脱位具有微创、安全、出血量少、关节功能恢复快的优势。Objective To investigate the efficacy of fixation through dual minimally invasive incisions and dual osseous channels with a loop titanium plate combined with a Dog-Bone titanium plate for acute RockwoodⅢacromioclavicular dislocation in comparison with open reduction and fixation with a clavicular hook plate.Methods A retrospective study was conducted to analyze the data of the 60 patients with acute typeⅢacromioclavicular dislocation who had been treated at Department of Orthopedics,Liaocheng People's Hospital from February 2019 to May 2022.There were 35 males and 25 females with an age of(43.2±8.0)years,and 34 left sides and 26 right sides affected.According to different surgical methods,they were divided into a double titanium plates group of 32 cases who had been treated by fixation through dual minimally invasive incisions and dual osseous channels with a loop titanium plate combined with a Dog Bone titanium plate and a hook plate group of 28 cases who had been treated by open reduction and internal fixation with a clavicle hook plate.The time from injury to operation was(2.1±1.3)d.The 2 groups were compared in terms of incision length,operation time,intraoperative bleeding,and visual analogue scale(VAS)pain score,Constant-Murley shoulder function score and the coracoclavicular distance on the affected side which were recorded preoperatively and at the last follow-up.Complications such as infection,loosening of internal fixation or secondary fracture were observed.Results There was no statistically significant difference in the preoperative general data between the 2 groups,indicating comparability(P>0.05).All patients were followed up for(11.2±2.1)months.The incision length in the double titanium plates group[(3.5±0.3)cm]was significantly shorter than that in the hook plate group[(6.2±0.7)cm],and the intraoperative bleeding[(45.3±7.5)mL]in the former was significantly less than that in the latter[(64.1±6.2)mL](P<0.05).However,there was no statistically significant difference in the operation time

关 键 词：肩锁关节 脱位 韧带 修复外科手术 

分 类 号：R687.4[医药卫生—骨科学] R687.3[医药卫生—外科学]