文章摘要

TightRope钢板与锁骨钩钢板联合喙肩韧带转位治疗Rockwood III型肩锁关节脱位的疗效比较

作者: 1储淼, 1周建刚, 1蒋涛, 1鲍卫国
1 宜兴市人民医院骨科,江苏 宜兴 214200
通讯: 周建刚 Email: orthopedist1987@163.com
DOI: 10.3978/j.issn.2095-6959.2022.09.024
基金: 江苏大学2021年度临床医学科技发展基金(JLY2021039)。

摘要

目的:比较TightRope钢板与锁骨钩钢板内固定联合喙肩韧带转位治疗Rockwood III型肩锁关节脱位的短期疗效。方法:采取回顾性病例对照的方法,分析2015年1月至2019年12月宜兴市人民医院收治的60例Rockwood III型肩锁关节脱位患者的临床资料,年龄42.4(21~60)岁。根据治疗方案,分为TightRope组与钩板韧带转位组,各30例。比较两组手术切口长度、手术时间、术中失血量、视觉模拟量表法(Visual Analog Scale,VAS)评分、Constant-Murley肩关节功能(Constant-Murley Shoulder Joint Function,CS)评分、术后肩锁关节功能恢复程度及并发症发生情况,并记录术后肩锁关节Karlsson疗效评分。结果:与钩板韧带转位组比较,TightRope组的平均手术时间较短[(57.30±5.27) min vs (63.30±5.49) min]、切口长度较短[(7.40±0.86) cm vs (10.13±1.07) cm]及术中失血量较少[(49.33±6.91) mL vs (64.53±9.83) mL],差异均有统计学意义(均P<0.001)。术后3个月TightRope组CS评分较钩钢板韧带转位组高[(91.07±3.69) vs (87.30±7.19)],差异有统计学意义(P<0.05)。术后6个月TightRope组VAS评分较钩钢板韧带转位组低 [(0.73±0.45) vs (1.43±0.82),P<0.001]。两组Karlsson评分优良率分别为100%(30/30)、96.7%(29/30),差异无统计学意义(P>0.05)。结论:TightRope钢板或锁骨钩钢板联合喙肩韧带转位治疗Rockwood III型肩锁关节脱位均可获得满意的短期疗效。与锁骨钩钢板联合喙肩韧带转位比较,TightRope在手术时间、手术切口长度及术中失血量各项中更占优势,且无需二次手术。在3个月时TighRope系统治疗的患者在活动度和肌力上可能恢复更好,6个月时疼痛感更轻。
关键词: 肩锁关节脱位;TightRope;锁骨钩钢板;喙肩韧带转位

Comparison of TightRope system and hook plate fixation with coracoacromial ligament transfer in the treatment of Rockwood type III acromioclavicular joint dislocation

Authors: 1CHU Miao, 1ZHOU Jiangang, 1JIANG Tao, 1BAO Weiguo
1 Department of Orthopaedics, Yixing People’s Hospital, Jiangsu University, Yixing Jiangsu 214200, China

CorrespondingAuthor: ZHOU Jiangang Email: orthopedist1987@163.com

DOI: 10.3978/j.issn.2095-6959.2022.09.024

Foundation: This work was supported by the 2021 Clinical Medical Science and Technology Development Fund Project of Jiangsu University, China (JLY2021039).

Abstract

Objective: The aim of this study was to evaluate the short-term efficacy of TightRope system versus hook plate fixation with coracoacromial ligament transfer in the treatment of Rockwood type III acromioclavicular joint dislocation. Methods: From January 2015 to December 2019, 60 cases in Yixing People’s Hospital with Rockwood type III acromioclavicular joint dislocation were retrospectively evaluated. The 60 cases, with an average age of 42.4 years (21 to 60 years), were divided into the TightRope group (n=30) and the Hook plate ligament transfer group (n=30) according to different treatment technique. The length of incision, procedure time, intraoperative blood loss, Visual Analog Scale (VAS) score, the Constant-Murley Shoulder Joint Function (CS) score, postoperative acromioclavicular recovery, and complications were compared between the 2 groups. The postoperative Karlsson efficacy score of the acromioclavicular joint was recorded. Results: The results showed that patients in the TightRope group had longer procedure time [(57.30±5.27) min vs (63.30±5.49) min], longer skin length [(7.40±0.86) cm vs (10.13±1.07) cm], less estimated blood loss [(49.33±6.91) mL vs (64.5±9.83) mL], and there were significant differences (all P<0.001). CS score at 3 months follow-up [(91.07±3.69) vs (87.30±7.19)] of the TightRope group was higher than that of the Hook plate ligament transfer group, and the difference was statistically significant (P<0.05). VAS score at 6 months follow-up of the TightRope group was lower than that of the Hook plate ligament transfer group [(0.73±0.45) vs (1.43±0.82), P<0.001]. The excellent rates of Karlsson score were 100% (30/30) and 96.7% (29/30), respectively, and the difference was not statistically significant (P>0.05). Conclusion: The treatment of Rockwood type III acromioclavicular joint dislocation by TightRope system or hook plate fixation with coracoacromial ligament transfer can obtain satisfactory short-term efficacy. However, the TightRope system exhibited obvious advantages in terms of incision length, procedure time, blood loss and no need for a second surgery. Patients received the TightRope system could have more range of motion and muscle strength at 3 months follow-up, less pain at 6 months follow-up.

Keywords: acromioclavicular joint dislocation; TightRope; clavicular hook plate; coracoacromial ligament transfer

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