目的 探討採用喙鎖韌帶重建聯合鉤鋼板固定或縫合錨固定治療肩鎖關節脫位的療效。方法 自2007年2月至2010年4月，將Rockwood Ⅲ型以上肩鎖關節脫位並符合納入排除標準的患者隨機分為鉤鋼板固定組和縫合錨固定組，分別應用雙股掌長肌腱重建喙鎖韌帶聯合鉤鋼板或縫合錨固定治療。定期隨訪患者，在X線片上測量肩鎖間距和喙鎖間距，末次隨訪應用Karlsson評分和Constant-Murley評分評估手術療效。應用SPSS 13.0統計學軟體[MSOffice1] 分析資料，等級資料應用χ2檢驗、計量資料應用兩樣本t檢驗分析，設定P＜0.05為差異有統計學意義。結果 16例患者失訪，89例患者獲得隨訪，隨訪時間24～42個月，平均30個月。[MSOffice2] 其中鉤鋼板固定組46例，縫合錨固定組43例，兩組患者在年齡、性別、損傷側別、受傷至手術時間和Rockwood分型方面具有可比性。X線片上肩鎖間距和喙鎖間距：術後6個月內兩組均無統計學差異（P>0.05）；術後24個月鉤鋼板固定組肩鎖間距和喙鎖間距均明顯大於縫合錨固定組（F=1.904，P=0.038；F=1.854，P=0.046）；鉤鋼板固定組術後24個月兩間距均大於其6
個月測量資料[MSOffice3] （F=1.863，P=0.041；F=1.842，P=0.043）。末次隨訪Constant-Murley評分鉤鋼板固定組平均88.5分,縫合錨固定組平均92.7分，鉤鋼板固定組明顯低於縫合錨固定組（F=0.475，P=0.017）。Karlsson評分縫合錨固定組患者功能優良率為95.4%，明顯優於鉤鋼板固定組的80.5%（X2=4.564，P=0.033）。結論 喙鎖韌帶重建結合縫合錨固定治療肩鎖關節脫位患者療效優於喙鎖韌帶重建結合鉤鋼板固定。鉤鋼板固定取出後，肩鎖間距和喙鎖間距顯著增加，可能與其療效較差有關。寧夏醫科大學總醫院創傷骨科安維軍
【關鍵詞】肩鎖關節；脫位；韌帶；內固定器
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: [email protected]
【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 (P>0.05). 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
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