摘要
目的：探讨钩钢板内固定术与改良Weaver-Dunn手术治疗肩锁关节脱位的临床疗效。方法：纳入新鲜肩锁关节Rockwood Ⅲ型脱位患者40例，分为钩钢板组和改良手术组，每组20例，其中男24 例，女16例；年龄18～63岁，平均（39.55±14.53）岁。钩钢板组20例，男13例，女7例；平均年龄（37.45±14.29）岁；左侧12例，右侧8例；车祸伤14例，坠落伤6例；术前Constant-Murley评分40.75±10.40.改良手术组20例，男11例，女9例；平均年龄（41.65±14.83）岁；左侧11例，右侧9例；车祸伤13例，坠落伤7例；术前Constant-Murley评分42.75±8.18.采用Lazzcano标准、Constant-Murley评分及影像学变化评估患者术前、术后肩关节功能变化。结果：所有患者获随访，时间7～32个月，平均24个月。根据Lazzcano标准，改良手术组优16例，良3例，差1例；无再脱位，有中度及以上疼痛者1例。钩钢板组优9例，良7例，差4例；再脱位1例，有中度及以上疼痛者3例。Constant-Murley评分：改良手术组术前42.75±8.18，术后末次随访时93.40±4.04，术后较术前提高。钩钢板组术前40.75±10.40，术后88.40±4.81，术后末次随访时92.05±4.49，术后及术后末次随访时均较术前提高。并且术后钩钢板组评分低于改良手术组末次随访时评分，但末次随访时钩钢板组与改良手术组比较差异无统计学意义。结论：异体肌腱移植，联同锚钉固定加强修补喙锁韧带，以及喙肩韧带部分转位、锁骨远端切除手术较锁骨钩钢板内固定手术疗效较好，固定可靠，术后并发症更少。
Objective： To study therapeutic effects between hook plate fixation and modified Weaver-Dunn surgery for the treatment of acromioclavicular joint dislocation. Methods： Forty patients with fresh acromioclavicular joint dislocations of type Ⅲ according to Rockwood classification were reviewed. All the patients were divided into two groups：hook plate fixation group and modified surgery group. There were 20 patients in hook plate fixation group,including 13 males and 7 females,with an average age of（37.45 ±14.29） years old;12 patients had injuries in the left and 8 patients had injuries in the right;preoperative Constant-Murley score was 40.75±10.40. And there were 20 patients in modified surgery group,including 11 males and 9 females,with an average age of（41.65±14.83）years old;11 patients had injuries in the left and 9 patients had injuries in the right;preoperative Constant-Murley score was 42.75±8.18. The Lazzcano standard,Constant-Murley score and imaging changes were used to evaluate shoulder joint function before and after surgery. Results： All the patients were followed up,and the duration ranged from 7 to 32 months,with an average of 24 months. According to Lazzcano evaluation,16 patients got an excellent result,3 good and 1 poor in modified surgery group with no re-dislocation,and 1 patient had pain more than middle degree;while in hook plate fixation group,9 patients got an excellent result,7 good and 4 poor,1 patient had re-dislocation,and 3 patients got pain more than middle degree. The therapeutic effects of modified surgery group were better than those of hook plate fixation group. Constant-Murley scores：preoperative 42.75±8.18 vs 93.40±4.04 at the latest follow-up in modified surgery group;preoperative 40.75±10.40 vs postoperative 88.40±4.81 and 92.05±4.49 at the latest follow-up in hook plate fixation group. The postoperative scores all improved compared to preoperative scores in two groups. And there was no statistical difference of scores at the latest follow-up between two groups. Conclusion： The surgery of allograft tendon transplantation combined with anchor fixation to strengthen coracoclavicular ligament,as well as part transposition of acromiocoracoid ligament and resection at the distal part of clavicle may got safety fixation and less postoperative complications compared with hook plate internal fixation.
出处
《中国骨伤》
CAS
2014年第1期4-8,共5页
China Journal of Orthopaedics and Traumatology
关键词
肩锁关节
脱位
骨折固定术
病例对照研究
Acromioclavicular joint Dislocations Fracture fixation Case-control studies
