三种术式治疗Rockwood III型肩锁关节脱位比较△

Comparison of three surgical techniques for Rockwood type III acromioclavicular dislocation

摘要:

［目的］ 比较全关节镜下双束三扣板喙锁韧带重建、单束双扣板重建及传统钉钩钢板固定三种手术方法治疗急性 Rockwood Ⅲ型肩锁脱位的临床效果。［方法］ 回顾性分析 2016 年 10 月—2020 年 12 月本院收治 49 例 Rockwood Ⅲ型肩锁脱位患者的临床资料。依据术前医患沟通结果，15 例采用双束重建，17 例采用单束重建，17 例采用钩板固定。比较三组围手术期、随访及影像结果。［结果］三组均顺利完成手术，无严重并发症。双束组和单束组切口长度、术中出血量、术后住院时间均显著优于钩板组（P<0.05）。随时间推移，三组的疼痛 VAS 评分均显著减少（P<0.05），术后 4、14 d，双束组和单束组 VAS 评分显著小于钩板组 （P<0.05）。所有患者均获随访 12 个月以上，双束组、单束组恢复完全负重活动时间显著早于钩板组 （P<0.05）。随时间推移，三组患者 Constant-Murley 肩关节功能评分、外展活动度（ROM）、前屈 ROM、内外旋 ROM 均显著增加（P<0.05）；术前三组间上述指标的差异均无统计学意义（P>0.05），术后 3 个月和末次随访时双束组上述指标明显优于单束组和钩板组 （P<0.05）。影像方面，与术前相比，术后三组患者肩锁间距（acromioclavicular distance, ACD） 和喙锁间距 （cora- coclavicular distance, CCD）均显著减少（P<0.05）。相应时间点，各组 ACD 的差异均无统计学意义（P>0.05），但是术后 2 周和末次随访，双束组、钩板组 CCD 显著小于单束组（P<0.05）。［结论］本研究表明双束喙锁韧带重建治疗急性 RockwoodⅢ型肩锁脱位的临床效果优于单束重建和钩板固定。

Abstract:

[Objective] To compare the clinical outcomes of arthroscopic double-bundle coracoclavicular reconstruction with 3 button plates (DB), arthroscopic single- bundle reconstruction with 2 button plates (SB) and traditional open hook plate fixation (HP) for acute Rockwood type III acromioclavicular dislocation. [Methods] A retrospective study was conducted on 49 patients who received surgical treatment for Rockwood type III acromioclavicular dislocation in our hospital from October 2016 to December 2020. According to preopera- tive doctor-patient communication, 15 patients underwent DB, 17 were treated with SB, while the remaining 17 received HP. The periopera- tive period, follow-up and imaging data were compared among the three groups. [Results] All the three groups were successfully operated on without serious complications. The DB and SB groups proved significantly superior to the HP group in terms of incision length, intraoper- ative blood loss and postoperative hospital stay (P＜0.05). The VAS score for pain decreased significantly over time during the early stage in all three groups (P＜0.05), which in DB and SB groups were significantly less than that in the HP group 4 and 14 days after surgery (P＜ 0.05). All patients were followed up for more than 12 months, the DB group and SB group resumed full weight-bearing activities significant- ly earlier than the HP group (P＜0.05). The Constant-Murley scores, abduction range of motion (ROM), forward flexion ROM, and internal-external rotation ROM significantly increased over time in all the three groups (P＜0.05). Although there was no significant differences in the abovesaid parameters among the three groups before surgery (P＞0.05), the DB group were significantly better in those than the SB group and HP group at 3 months and the latest follow-up (P＜0.05). As for imaging, the acromioclavicular distance (ACD) and coracoclavicular dis- tance (CCD) significantly reduced postoperatively in all the three groups compared with those preoperatively (P＜0.05). There was no signifi- cant difference in ACD among all groups at time points accordingly (P＞0.05), but the DB group and SB group proved significantly superior to the HP group in term of CCD at 2 weeks postoperatively and the latest follow-up (P＜0.05). [Conclusion] The arthroscopic DB coracocla- vicular reconstruction with 3 button plates does achieve better clinical outcomes than the SB reconstruction and traditional open HP fixa- tion for acute Rockwood type III acromioclavicular dislocation in this study.