目的 探讨采用喙锁韧带重建联合钩钢板固定或缝合锚固定治疗肩锁关节脱位的疗效。方法自2007年2月至2010年4月，将Rockwood Ⅲ型以上肩锁关节脱位并符合纳入排除标准的患者随机分为钩钢板固定组和缝合锚固定组，分别应用双股掌长肌腱重建喙锁韧带联合钩钢板或缝合锚固定治疗。定期随访患者，在X线片上测量肩锁间距和喙锁间距，末次随访应用Karlsson评分和Constant-Murley评分评估手术疗效。应用SPSS 13.0统计学软件[MSOffice1] 分析数据，等级资料应用χ2检验、计量资料应用两样本t检验分析，设定P＜0.05为差异有统计学意义。结果16例患者失访，89例患者获得随访，随访时间24～42个月，平均30个月。[MSOffice2] 其中钩钢板固定组46例，缝合锚固定组43例，两组患者在年龄、性别、损伤侧别、受伤至手术时间和Rockwood分型方面具有可比性。X线片上肩锁间距和喙锁间距：术后6个月内两组均无统计学差异（P0.05）；术后24个月钩钢板固定组肩锁间距和喙锁间距均明显大于缝合锚固定组（F=1.904，P=0.038；F=1.854，P=0.046）；钩钢板固定组术后24个月两间距均大于其6个月测量数据[MSOffice3] （F=1.863，P=0.041；F=1.842，P=0.043）。末次随访Constant-Murley评分钩钢板固定组平均88.5分,缝合锚固定组平均92.7分，钩钢板固定组明显低于缝合锚固定组（F=0.475，P=0.017）。Karlsson评分缝合锚固定组患者功能优良率为95.4%，明显优于钩钢板固定组的80.5%（X2=4.564，P=0.033）。结论喙锁韧带重建结合缝合锚固定治疗肩锁关节脱位患者疗效优于喙锁韧带重建结合钩钢板固定。钩钢板固定取出后，肩锁间距和喙锁间距显著增加，可能与其疗效较差有关。宁夏医科大学总医院创伤骨科安维军
【关键词】肩锁关节；脱位；韧带；内固定器
Comparative study on the treatment of acromioclavicular joint dislocation: coracoclavicular ligament reconstruction combined with hook plate fixation or suture-anchor fixation
AN Wei-jun, SUN Jian-bin, YE Peng, GUO Wei-wei. Department of traumatic orthopedics, The General Hospital of Ningxia Medical University, Yinchuan 75004,China
Corresponding author: AN Wei-jun, Email: anweijun939@163.com
【Abstract】 [MSOffice4] Objective To investigate the clinical outcomes of acromioclavicular joint (ACJ) dislocation treated with coracoclavicular ligament (CCL) reconstruction and hook plate fixation/suture-anchor fixation. Methods Patients with Rockwood type III or severer ACJ dislocations were randomly divided into two groups February 2007 to April 2010. They were treated with CCL reconstruction using double bundle of Palmaris longus, and subsequently fixed with hook plates or suture-anchors. Patients were followed up, and the AC distance and CC distance were measured on the postoperative X-ray films, and the outcomes were assessed according to Karlsson criteria and Constant-Murley shoulder score. SPSS 13.0 was employed to analyze the data. Ranked data was analyzed with the use ofχ2 test and measurement data with two sample t test. P less than 0.05 was considered as statistical significant difference. Result 89 patients were followed up for at least 24 months. There were 46 cases in hook plate fixation group and 43 cases in such-anchor fixation group, without significant difference in age, sex, injured side and Rockwood classification between both groups. Between both groups, no statistical difference was detected in the AC and CC distance measured within six months after operation (P0.05). The AC and CC distances of hook plate fixation group measured in 24 months postoperatively were larger than those in such-anchor fixation group, respectively (F=1.904,P=0.038;F=1.854,P=0.046). In hook plate fixation group, the AC and CC distances measured in 24 months postoperatively were larger than those measured in 6 month postoperatively, respectively(F=1.863,P=0.041; F=1.842,P=0.043). According to Constant-Murley shoulder score, the average score was 88.5 for hook plate fixation group and 92.7 for such-anchor fixation group(F=0.475,P=0.017). According to Karlsson Criteria, the excellent and good rate of the functional recovery was 95.4% in such-anchor fixation group, better than hook plate fixation group (X2=4.564,P=0.033). Conclusion The clinical outcomes of ACJ dislocation treated with CCL reconstruction and suture-anchor fixation are better than those treated with CCL reconstruction and hook plate fixation. The AC and CC distances increase after the removal of hook plate, which may be associated with poor functional recovery.
【Key Words】 Acromioclavicular joint; Dislocations; Ligaments; Internal fixators
