TightRope与钩钢板治疗肩锁关节脱位的比较△

Coracoclavicular ligament reconstruction with TightRope versus internal fixation with hook plate for acromioclavicular dis⁃ location

摘要:

［目的］比较应用改良 TightRope 系统（TR）Y 字形重建喙锁韧带与钩钢板固定治疗肩锁关节脱位的临床效果。［方法］ 回顾性分析 2017 年 1 月—2020 年 11 月手术治疗肩锁关节脱位 30 例患者的临床资料，依据术前医患沟通结果，9 例采用改良 TR 重建喙锁韧带（TR 组），21 例采用锁骨钩钢板固定（钩板组），比较两组围手术期、随访及影像结果。［结果］两组患者均顺利完成手术，术中无血管、神经损伤和骨折等并发症发生。两组手术时间、切口长度、术中出血量、透视次数、切口愈合等级、住院时间的差异均无统计学意义（P>0.05）。所有患者均获随访，平均随访时间（15.34±3.26）个月。两组患者恢复完全负重活动时间的差异无统计学意义（P>0.05）。术后随时间推移，两组 VAS 评分显著减少（P<0.05），而 Constant 评分、肩上举 ROM 均显著增加（P<0.05）。术后 3 个月和末次随访时，TR 组在 VAS 评分、Constant 评分、肩上举 ROM 均显著优于钩板组 （P<0.05）。影像方面，两组患者末次随访时 CCD 和 ACD 均较术前显著减少（P<0.05）。相应时间点，两组 CCD 和 ACD 的差异均无统计学意义（P>0.05）。［结论］改良 TightRope 系统 Y 字形重建喙锁韧带治疗 Rockwood 分型Ⅲ~Ⅴ型肩锁关节脱位的临床效果优于锁骨钩钢板固定。

Abstract:

[Objective] To compare the clinical outcomes of coracoclavicular ligament reconstruction with modified Y-shaped Tight- Rope system (TR) versus internal fixation with hook plate for acromioclavicular dislocation. [Methods] A retrospective study was conducted on 30 patients who received surgical treatment for acromioclavicular dislocation in our hospital from January 2017 to November 2020. Ac- cording to the preoperative doctor-patient communication results, 9 patients underwent coracoclavicular ligament reconstruction with modi- fied TR (TR group) , while the other 21 patients had fixation with hook plate (hook plate group). The perioperative, follow-up and imaging results of the two groups were compared. [Results] Both groups of patients successfully completed the operation, and there were no compli- cations such as vascular and nerve injury and fracture. There was no significant difference in operation time, incision length, intraoperative bleeding, fluoroscopy times, incision healing and hospital stay between the two groups (P＞0.05) . All patients were followed up for an aver- age of (15.34±3.26) months. There was no significant difference in the recovery time of complete weight-bearing activities between the two groups (P＞0.05) . The VAS scores decreased significantly (P＜0.05) , while Constant-Murley score and ROM of shoulder lift were signifi- cantly increased over time in both groups (P＜0.05) . At 3 months and the latest follow-up, the TR group proved significantly superior to the hook plate group in terms of VAS score, Constant-Murley score and ROM (P＜0.05) . Radiographically, the coracoclavicular distance (CCD) and acromioclavicular distance (ACD) significantly reduced in both groups at the latest follow-up compared with those preoperatively (P＜ 0.05) , whereas there was no significant difference in CCD and ACD between the two groups at any corresponding time points (P＞0.05) . [Conclusion] The coracoclavicular ligament reconstruction with modified Y-shaped TightRope is superior to the internal fixation with hook plate for Rockwood type III~V acromioclavicular dislocation in term of clinical outcomes.