低切迹袢钢板与钩钢板固定肩锁关节脱位的比较△

Low profile loop plate versus hook plate for fixation of acromioclavicular dislocation

摘要:

[目的]比较低切迹袢钢板与钩钢板治疗肩锁关节脱位的临床疗效。[方法]回顾性分析 2020 年 1 月—2023 年 6 月本院收治的 Rockwood III~V 型肩锁关节脱位 46 例患者的临床资料，依据术前医患沟通结果，22 例行低切迹带袢钛板系统固定 （袢板组），24 例行锁骨钩板固定 （钩板组），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， 两组手术时间、住院时间、愈合等级的差异无统计学意义 （P＞0.05），而袢板组切口长度 [(4.1±0.8) cm vs (6.0±0.6) cm, P＜ 0.001]、术中出血量 [(34.8±5.2) mL vs (55.4±7.8) mL, P＜0.001] 及主动活动时间 [(1.5±0.1) d vs (1.6±0.0) d, P＜0.001] 均优于钩板组。 所有患者均获随访 12 个月以上，袢板组恢复完全负重活动时间 [(46.1±3.0) d vs (53.9±4.7) d, P＜0.001] 显著早于钩板组。随时间推移，两组患者 VAS 评分、Constant-Murley 肩关节功能评分、前屈上举 ROM、外展上举 ROM 均显著改善 （P＜0.05）。术后 3 个月和末次随访时，袢板组 VAS 评分 [(2.2±0.8) vs (2.9±0.8), P=0.007; (0.8±0.6) vs (1.9±0.8), P＜0.001]、Constant-Murley 肩关节功能评分 [(84.2±3.6) vs (79.0±2.7), P＜0.001; (93.9±2.0) vs (91.1±2.6), P=0.023]、前屈上举 ROM [(142.1±6.5)° vs (113.3±11.1)°, P＜0.001; (170.2±5.9)° vs (151.7±9.6)°, P＜0.001]、外展上举 ROM [(127.9±5.0)° vs (107.3±8.7)°, P＜0.001; (155.9±5.7)° vs (141.0±8.2)°, P＜0.001] 均显著优于钩板组。影像方面，与术前相比，术后两组肩锁间距 （acromioclavicular distance, ACD） 和喙锁间距 （coracoclavicu- lar distance, CCD） 均显著减少 （P＜0.05）。相应时间点，两组患者之间 CCD 和 ACD 的差异均无统计学意义 （P＞0.05）。[结论] 低切迹带袢钛板固定肩锁关节脱位的临床疗效优于钩钢板固定。

Abstract:

[Objective] To compare the clinical efficacy of low-profile loop plate (LP) versus hook plate (HP) for fixation of acromiocla- vicular dislocation. [Methods] A retrospective study was conducted on 46 patients who had Rockwood III-V acromioclavicular dislocation treated surgically in our hospitals from January 2020 to June 2023. According to the preoperative doctor-patient communication, 22 patients underwent LP, while other 24 patients underwent HP. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had corresponding surgical procedures performed successfully without significant differences in operation time, hospital stay, healing grade between the two groups (P＞0.05). However, the LP group was significantly superior to the HP group in terms of incision length [(4.1±0.8) cm vs (6.0±0.6) cm, P＜0.001], blood loss, [(34.8±5.2) mL vs (55.4±7.8) mL, P＜0.001] and active activity time [(1.5±0.1) days vs (1.6±0.0) days, P＜0.001]. All patients in both groups were followed up for more than 12 months, and the LP group resumed full weight-bearing activity significantly earlier than the HP group [(46.1±3.0) days vs (53.9±4.7) days, P＜0.001]. As time went on, VAS score, Constant-Murley score, forward flexion elevation ROM and abduction elevation ROM were significantly improved in both groups (P＜0.05). At 3 months and the last follow-up, the LP group was significantly better than the HP group in terms of VAS score [(2.2±0.8) vs (2.9±0.8), P=0.007; (0.8±0.6) vs (1.9±0.8), P＜0.001], Constant-Murley score [(84.2±3.6) vs (79.0±2.7), P＜0.001; (93.9±2.0) vs (91.1±2.6), P=0.023], forward flexion elevation ROM [(142.1±6.5)° vs (113.3±11.1)°, P＜0.001; (170.2±5.9)° vs (151.7±9.6)°, P＜0.001], and abduction elevation ROM [(127.9±5.0)° vs (107.3±8.7)°, P＜0.001; (155.9±5.7)° vs (141.0±8.2)°, P＜0.001]. As for imaging, the acromiocla-vicular distance (ACD) and coracoclavicular distance (CCD) in both groups decreased significantly after surgery compared with those preoperatively (P＜0.05). At any corresponding time points, there were no significant differences in CCD and ACD between the two groups (P＞ 0.05). [Conclusion] The low-profile loop plate is superior to the hook plate for fixation of acromioclavicular dislocation.