镜下与开放可调袢长的双微钢板治疗急性肩锁脱位

Arthroscopic versus small- incision reduction and fixation of acute acromioclavicular dislocation with adjustable suture loop and double mini plates

摘要:

［目的］ 比较改良直接前路肩关节镜下与开放双切口联合自制可调长度双微钢板治疗急性肩锁关节脱位的临床疗效。［方法］ 回顾性分析 2017 年 1 月—2020 年 7 月采用可调袢长的双微钢板复位固定急性肩锁关节脱位 38 例患者的临床资料。依据术前医患沟通结果，21 例行改良直接前路肩关节镜下手术（镜下组），17 例行开放双切口手术（开放组）。比较两组的围手术期、随访和影像学资料。［结果］ 两组患者均顺利完成手术，均无神经、血管损伤等严重并发症。镜下组切口总长度、术中透视次数均显著优于开放组 （P<0.05）。患者均随访 （16.37±3.56） 个月，两组完全负重活动时间差异无统计学意义 （P>0.05）。随时间推移，两组 VAS 评分显著减少 （P<0.05），而上举 ROM、Constant-Murley 评分及 UCLA 评分显著增加 （P< 0.05）；相应时间点，两组上述指标的差异均无统计学意义（P>0.05）。影像方面，末次随访时，两组肩锁间隙（AC）及喙锁间隙 （CC） 均较术前显著减小 （P<0.05），相应时间点两组间上述指标的差异无统计学意义 （P<0.05）。［结论］ 镜下与开放可调袢长的双微钢板均可有效复位固定急性肩锁脱位，前者具有切口小、透视少等优势。

Abstract:

[Objective] To compare the clinical outcomes of modified direct anterior arthroscopy versus double small incisions for re- duction and fixation of acute acromioclavicular by using self-made adjustable suture loop and double mini plates. [Methods] A retrospec- tive study was conducted on 38 patients who received reduction and fixation of acute acromioclavicular with self-made adjustable suture loop and double mini plates in our department from January 2017 to July 2020. According to preoperative patient-doctor communication, 21 patients underwent modified direct anterior arthroscopy (the MDA group) , while the remaining 17 patients received open small doubleincision procedure (the SDI group) . The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the 38 patients had surgical procedures performed smoothly without serious complications, such as neurovascular injuries. The MDA group proved significantly superior to the SDI group in terms of total incision length and intraoperative fluoroscopy (P＜0.05) . All the patients were followed up for 12-30 months, with an average of (16.37±3.56) months, without a statistically significant difference in the time to re- sume full-weight bearing activity between the two groups (P＞0.05) . The VAS score significantly decreased, whereas the Constant-Murley score and UCLA score significantly increased in both groups at 1 month, 6 months after surgery and at the last follow-up compared with those preoperatively (P＜0.05) , however, which were not statistically different between the two groups at any matching time points (P＞0.05) . Radiographically, the acromioclavicular distance (AC) and coracoclavicular distance measured in both groups decreased significantly 6 months after surgery and at the latest follow-up compared with those preoperatively (P＜0.05) , whereas which were not significantly differ- ent between the two groups at any corresponding time point (P＞0.05) . [Conclusion] Both modified direct anterior arthroscopy and open pro- cedure with double small incisions for reduction and fixation of acute acromioclavicular dislocation by using self-made adjustable suture loop and double mini plates do achieve satisfactory clinical outcomes, the former has advantages of smaller incision and less fluoroscopy.