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中华卫生应急电子杂志 ›› 2016, Vol. 02 ›› Issue (01) : 21 -25. doi: 10.3877/cma.j.issn.2095-9133.2016.01.007

所属专题: 文献

论著

锁骨钩钢板内固定与Endobutton带袢钢板喙锁韧带重建治疗急性不稳定肩锁关节脱位的疗效对比
刘志元1,(), 朱建国1, 杨雷1   
  1. 1. 213000 常州市武进人民医院南院骨科
  • 收稿日期:2016-01-25 出版日期:2016-02-18
  • 通信作者: 刘志元

Comparison of hook plate fixation and ligament reconstruction in treatment of acute unstable acromioclavicular joint dislocation

Zhiyuan Liu1,(), Jianguo Zhu1, Lei Yang1   

  1. 1. Department of Orthopedics, Changzhou Wunjin People’s Hospital, Changzhou 213000, China
  • Received:2016-01-25 Published:2016-02-18
  • Corresponding author: Zhiyuan Liu
  • About author:
    Corresponding author: Liu Zhiyuan, Email:
引用本文:

刘志元, 朱建国, 杨雷. 锁骨钩钢板内固定与Endobutton带袢钢板喙锁韧带重建治疗急性不稳定肩锁关节脱位的疗效对比[J/OL]. 中华卫生应急电子杂志, 2016, 02(01): 21-25.

Zhiyuan Liu, Jianguo Zhu, Lei Yang. Comparison of hook plate fixation and ligament reconstruction in treatment of acute unstable acromioclavicular joint dislocation[J/OL]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2016, 02(01): 21-25.

目的

比较锁骨钩钢板内固定和Endobutton带袢钢板重建喙锁韧带两种方法治疗急性不稳定性肩锁关节脱位的临床疗效以及放射学影像差异。

方法

将江苏大学附属武进医院收治的50例接受手术的急性不稳定性肩锁关节脱位患者分为锁骨钩钢板组(A组,20例)和喙锁韧带重建组(B组,30例)。采用CMS评分,VAS评分以及喙突锁骨间距(coracoclaviculardistance,CCD)来观察和比较两组之间的差异。

结果

A组CMS评分为(94.4±6.97)分,B组为(95.87±3.50)分。A组VAS评分为(0.85±0.93)分,B组为(0.87±0.82)分。放射影像学:肩锁关节在两组中均得到满意复位,手术前后CCD:A组为术前(15.91±5.29) mm,术后(6.94±2.90) mm,间距改善率为(263.00±181.45)% ;B组为术前(15.10±6.43) mm,术后(5.54±2.10)mm,间距改善率为(293.67±116.39)%。间距的改善A组与B组无明显差异(P>0.05)。并发症:A组和B组均发生肩锁关节半脱位,但A组发生率(15%)低于B组(26.7%)。但A组存在很高的肩峰下骨溶解(80%)以及较高的肩锁关节骨关节炎发生率(25%),喙锁韧带骨化的发生率(35%)同样明显高于B组(13.3%)。

结论

锁骨钩钢板内固定和喙锁韧带重建治疗急性不稳定性肩锁关节脱位均能够取得较满意的临床疗效。锁骨钩钢板长期放置会引起较多的并发症,建议尽早去除。肩锁关节半脱位是喙锁韧带重建常见的主要并发症。

Objective

To compare clinical and radiographic outcomes of hook plate fixation and coracoclavicular ligament reconstruction in the treatment of acute unstable acromioclavicular joint dislocation.

Methods

Fiftypatients with acute unstable dislocation of the acromioclavicular joint were enrolled in the study and divided into two groups according to the treatment modality, ie, internal fixation with a hook plate group (Group I, 20 cases) and coracoclavicular ligament reconstruction group (Group II, 30 cases). The clinical outcomes were evaluated using Constant- Murley score (CMS) and visual analog scale (VAS) and the radiographic outcomes assessed based on coracoclaviculardistance (CCD).

Results

The mean CMS score was(94.4±6.97) points and (95.87±3.50) points in Groups I and II, respectively, with no statistical difference. The mean VAS scores at the final follow-up was (0.85±0.93) points and (0.87±0.82) points in Groups I and II, respectively, with no statistical difference. The acromioclavicular joints were well reduced in both groups. CCDwas improved from preoperative (15.91±5.29)mm to postoperative (6.94±2.90)mm in Group I, with an improvement of (263.00±181.45)%, and from preoperative (15.10±6.43)mm to postoperative (5.54±2.10)mm in Group II, with an improvement of (293.67±116.39)%. The improvement in Group I was not significantly superior to that in Group II(P>0.05) Subluxation was observed in both groups, with higher incidence in Group II(26.7%) than that in Group I(15%). However, erosions of the acromion undersurface and osteoarthritis of acromioclavicular were only observed in group I, with an incurrence of 80% and 25%, respectively. Furthermore, coracoclavicular ligament ossification shown more frequently in group I (35%) than group II (13.3%).

Conclusions

For acute unstable acromioclavicular joint dislocation, hook plate fixation and coracoclavicular ligament reconstruction can attain comparable satisfactory clinical and radiographicoutcomes. Hook plate should be moved earlier to avoid the complication. Subluxation is the major complication of ligament reconstruction.

表1 锁骨钩钢板组和喙锁韧带重建组患者基本资料比较
表2 锁骨钩钢板组和喙锁韧带重建组患者术后临床疗效比较(±s)
表3 锁骨钩钢板组和喙锁韧带重建组患者放射影像学比较(mm,±s)
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