目的:探讨单个小切口蜂窝钛板治疗急性肩锁关节脱位的临床效果。
方法:回顾性分析2019年12月至2021年12月收治的40例急性肩锁关节脱位患者的临床资料,根据手术方式不同分为两组。其中,20例患者采用单个小切口蜂窝钛板固定(钛板组),包括11名男性和9名女性,年龄23~65岁,平均(47.40±12.58)岁;左侧12例,右侧8例;Ⅲ型11例,3例Ⅳ型患者,根据Rockwood分类,Ⅴ型6例。20例患者采用锁骨钩钢板固定(锁骨钩组),包括8名男性和12名女性,年龄24~65岁,平均(48.40±12.08)岁;左侧12例,右侧8例;Ⅲ型10例,2例Ⅳ型,根据Rockwood分型为Ⅴ型8例。手术时间,切口长度,术中失血,住院,比较两组患者的视觉模拟评分(VAS)和肩关节功能Constant-Murley评分。之前记录受累肩关节的前后位X光片,手术后立即和6个月,并对喙锁距离进行了测量和比较。
结果:两组患者均顺利完成手术,无严重并发症。所有患者随访6~15个月,平均(11.9±4.8)个月。没有切口感染,内部植物断裂或失效,骨隧道骨折等并发症。钛板组切口长度(35.90±3.14)mm明显短于锁骨钩组(49.30±3.79)mm,差异有统计学意义(P<0.05)。手术时间无显著差异,术中出血量和住院时间比较差异无统计学意义(P>0.05)。术后1个月和3个月,钛板组VAS评分低于锁骨钩组(P<0.05)。钛板组术后1、3、6个月的Connstant-Murley评分分别为(86.80±1.36),(91.60±2.32)和(94.90±2.22),锁骨钩组分别为(78.45±5.47),(85.55±2.01)和(90.25±1.92),均高于锁骨钩组(P<0.05)。两组术后即刻和术后6个月的喙锁距离比较,差异无统计学意义(P>0.05)。
结论:对于急性肩锁关节脱位的治疗,单个小切口结合蜂窝钛板具有切口较短的优点,无需二次手术即可快速恢复肩关节功能,对患者有很好的满意度。
OBJECTIVE: To explore clinical effect of single small incision with honeycomb titanium plate in treating acute acromioclavicular dislocation.
METHODS: The clinical data of 40 patients with acute acromioclavicular dislocation admitted from December 2019 to December 2021 were retrospectively analyzed and divided into two groups according to different surgical methods. Among them, 20 patients were fixed with single small incision with honeycomb titanium plate (titanium plate group), including 11 males and 9 females, aged from 23 to 65 years old with an average of (47.40±12.58) years old;12 patients on the left side, 8 patients on the right side;11 patients with type Ⅲ, 3 patients with type Ⅳ, and 6 patients with type Ⅴ according to Rockwood classification. Twenty patients were fixed with clavicular hook plate (clavicular hook group), including 8 males and 12 females, aged from 24 to 65 years old with an average of (48.40±12.08) years old;12 patients on the left side, 8 patients on the right side;10 patients with type Ⅲ, 2 patients with type Ⅳ, and 8 patients with type Ⅴ according to Rockwood classification. Operative time, incision length, intraoperative blood loss, hospital stay, visual analogue scale (VAS) and Constant-Murley score of shoulder joint function were compared between two groups. Anteroposterior radiographs of the affected shoulder joint were recorded before, immediately and 6 months after surgery, and the coracoclavicular distance was measured and compared.
RESULTS: Both groups of patients were successfully completed operation without serious complications. All patients were followed up for 6 to 15 months with an average of (11.9±4.8) months. There were no incisional infection, internal plant fracture or failure, bone tunnel fracture and other complications occurred. The incision length of titanium plate group (35.90±3.14) mm was significantly shorter than that of clavicular hook group (49.30±3.79) mm (P<0.05). There were no significant difference in operative time, intraoperative blood loss and hospital stay between two groups (P>0.05). At 1 and 3 months after operation, VAS of titanium plate group was lower than that of clavicular hook group (P<0.05). Connstant-Murley scores in titanium plate group at 1, 3 and 6 months after operation were (86.80±1.36), (91.60±2.32) and (94.90±2.22), respectively;and in clavicular hook group were (78.45±5.47), (85.55±2.01) and (90.25±1.92), which were higher than that of clavicular hook group (P<0.05). There was no significant difference in coracoclavicular distance between two groups immediately and 6 months after operation(P>0.05).
CONCLUSIONS: For the treatment of acute acromioclavicular joint dislocation, single small incision combined with honeycomb titanium plate have advantages of shorter incision, fast recovery of shoulder joint function without the second operation, and has good satisfaction of patient.