摘要
目的 ：对比锁骨钩钢板内固定术与改良Weaver-Dunn法联合锁骨钩钢板内固定术治疗TossyⅢ型肩锁关节脱位的临床疗效。方法：回顾性分析2012年1月至2014年1月手术治疗的41例新鲜TossyⅢ型肩锁关节脱位患者的临床资料,按其手术方式分为锁骨钩钢板内固定术（A组）和改良Weaver-Dunn法联合锁骨钩钢板内固定术（B组）。A组21例,男15例,女6例,年龄17~51岁,平均（31.60±12.58）岁,术前Constant-Murley评分40.25±9.80,采用锁骨钩钢板内固定术;B组20例,男13例,女7例,年龄18~48岁,平均（29.40±11.27）岁,术前Constant-Murley评分41.45±8.81,采用改良Weaver-Dunn法联合锁骨钩钢板内固定术。比较两组患者的手术时间、术中出血量、手术前后影像学变化、术后并发症,分别于术后3、6、12个月时,采用Constant-Murley评分进行疗效评价。结果：A组手术时间（40.50±24.36）min,术中出血量（75.30±30.36）ml;B组手术时间（60.10±23.55）min,术中出血量（100.70±40.12）ml;A组21例获随访,时间12~18个月,平均（14.8±3.1）个月;B组20例获随访,时间12~14个月,平均（13.6±1.5）个月。两组手术时间、术中出血量比较差异有统计学意义。两组随访时间比较差异无统计学意义。术后A组6例出现并发症,B组3例,两组比较差异无统计学意义。术后6个月时,A组Constant-Murley评分为88.85±4.23,B组为92.15±3.82,两组比较差异有统计学意义（t=-2.56,P=0.022〈0.05）;其余各时间点比较差异无统计学意义。结论 ：锁骨钩钢板内固定术与改良Weaver-Dunn法联合锁骨钩钢板内固定术均是治疗TossyⅢ型肩锁关节脱位的有效手术方法。锁骨钩钢板内固定术较改良Weaver-Dunn法联合锁骨钩钢板内固定术创伤小,但改良Weaver-Dunn法联合锁骨钩钢板内固定术重建的喙锁韧带更牢固,且能早期取出锁骨钩钢板,可以更早地改善患者的肩关节功能。
Objective：To compare therapeutic effects of clavicular hook plate fixation and modified Weaver Dunn surgery combined with clavicular hook plate fixation in treating Tossy type Ⅲ acromioclavicular joint dislocation. Methods：Forty one patients with Tossy type Ⅲacromioclavicular dislocation treated by operation were retrospectively analysis from January 2012 to January 2014. The patients were divided into clavicular hook plate fixation group（group A） and modified Weaver Dunn surgery combined with clavicular hook plate fixation（group B） according to surgical procedures. In group A,there were 15 males and 6 females aged from 17 to 51 years old with an average of（31.60±12.58） years old,preoperative Constant Murley score was 40.25±9.80,and treated with clavicular hook plate fixation. In group B,there were 13 males and 7 females aged from18 to 48 years old with an average of（29.40±11.27） years old,preoperative Constant Murley score was 41.45±8.81,and treated with modified Weaver Dunn surgery combined with clavicular hook plate fixation. Operative time,blood loss,imaging changes before and after operation,postoperative complications were compared; Constant Murley score at 3,6 and 12 months after operation were evaluated. Results：In group A,operative time was（40.50±24.36） min,blood loss was（75.30±30.36） ml;In group B,operative time was（60.10±23.55） min,blood loss was（100.70±40.12） ml. Twenty one patients in group A were followed up from 12 to 18 months with an average of（14.8±3.1） months;20 patients in group B were followed up from 12 to 14 months with an average of（13.6±1.5） months. There were no significant differences in operative time,blood loss and follow up time between two groups. Complications were in six patients of group A and 3 patients of group B,and there were no significant meaning between two groups. At 6 months after operation,Constant Murley score in group A was 88.85 ±4.23,92.15 ±3.82 in group B; and had significant meaning between two groups（t=-2.56,P=0.022〈0.05）. While there were no differences in Constant Murley score in other times. Conclusion：Both of clavicular hook plate fixation and modified Weaver Dunn surgery combined with clavicular hook plate fixation are effective operative methods for the treatment of Tossy type Ⅲ acromioclavicular dislocation. Clavicular hook plate fixation has advantage of less trauma,while modified Weaver Dunn surgery combined with clavicular hook plate fixation could reconstruct coracoclavicular ligament more stronger,clavicular hook plate could take out earlier,also improve shoulder joint function earlier.
出处
《中国骨伤》
CAS
2015年第12期1141-1146,共6页
China Journal of Orthopaedics and Traumatology
关键词
肩锁关节
脱位
骨折固定术
内
Acromioclavicular joint
Dislocations
Fracture fixation
internal
