【摘要】 目的比较保守治疗、切开复位钩钢板固定和改良闭合复位TightRope袢钢板固定治疗RockwoodⅢ型肩锁关节脱位的临床疗效。方法回顾性分析2014年9月～2018年11月有完整随访料85例RockwoodⅢ型肩锁关节脱位的临床资料,根据治疗方式分为3组:保守组31例,钩板组35例,TightRope组19例。比较3组治疗前和治疗后12个月喙锁距离,治疗前和治疗后3 d、6周、6个月、12个月上肢功能(Disabilities of the Arm, Shoulder and Hand,DASH)评分、Constant-Murley评分、疼痛视觉模拟评分(Visual Analogue Scale,VAS),以及并发症发生率。结果治疗后12个月保守组、钩板组和TightRope组喙锁距离分别为(20.6±2.4)、(13.0±1.8)、(12.3±1.9)mm,3组间差异有显著性(F=142.165,P=0.000),保守组喙锁距离显著大于钩板组和TightRope组(P=0.000,P=0.000),钩板组和TightRope组差异无统计学意义(P=0.269)。治疗后3 d 3组间DASH、Constant-Murley评分差异均有显著性,即TightRope组显著优于钩板组(P<0.05),钩板组显著优于保守组(P<0.05)。治疗后6周,TightRope组DASH、Constant-Murley评分显著优于钩板组与保守组(P<0.05),钩板组与保守组之间差异无统计学意义(P>0.05)。治疗后3 d、6周TightRope组疼痛VAS评分显著优于钩板组和保守组(P<0.05),钩板组和保守组VAS评分差异无统计学意义(P>0.05)。治疗前和治疗后6、12个月3组DASH、Constant-Murley、VAS评分差异无统计学意义(P>0.05)。保守组、钩板组、TightRope组并发症发生率分别为6.4%(2/31)、11.4%(4/35)、5.3%(1/19),差异无统计学意义(χ~2=0.825,P=0.662)。结论对于RockwoodⅢ型肩锁关节脱位,3种治疗方法均可获得满意的功能。改良微创TightRope可迅速恢复关节的稳定性,减轻疼痛,改善功能、避免残留畸形,尤其适用于对美观和早期功能要求高的患者。更多还原

【Abstract】 Objective To compare the clinical effect of conservative treatment, hook plate fixation and modified minimally invasive TightRope fixation in the treatment of Rockwood type Ⅲ acromioclavicular joint dislocation. Methods A retrospective case-controlled study was conducted to analyze the clinical data of 85 patients with Rockwood type Ⅲ acromioclavicular joint dislocation from September 2014 to November 2018. According to the different treatments, the patients were divided into three groups: conservative group(n=31), hook plate group(n=35) and TightRope group(n=19). The coracoclavicular distance at the time of injury and 12 th months after treatment, the Disabilities of the Arm, Shoulder and Hand(DASH) score, Constant-Murley score and VAS score before treatment, 3 rd day, 6 th week, 6 th month and 12 th month after treatment, and the incidence of complications were compared among the three groups. Results At the 12 th month after treatment, the average coracoclavicular distance in the conservative group(20.6±2.4)mm was significantly higher than that in the hook plate group(13.0±1.8)mm and TightRope group(12.3±1.9)mm(F=142.165,P=0.000). The coracoclavicular distance in the conservative group was significantly larger than that in the hook plate group and TightRope group(P=0.000, P=0.000), but there was no significant difference between the hook plate group and TightRope group(P=0.269). There were significant differences in DASH and Constant-Murley scores among the three groups 3 days after treatment, that is, the TightRope group was significantly better than the hook plate group(P<0.05), and the hook plate group was significantly better than the conservative group(P<0.05). The DASH and Constant-Murley scores of TightRoap group were significantly better than those of hook plate group and conservative group 6 weeks after treatment(P<0.05),but there was no significant difference between hook plate group and conservative group(P<0.05). The VAS score of TightRope group was significantly better than that of hook plate group and conservative group 3 days and 6 weeks after treatment(P<0.05), but there was no significant difference in VAS score between hook plate group and conservative group(P>0.05). There was no significant difference in DASH, Constant-Murley and VAS scores among the three groups before treatment and 6 and 12 months after treatment(P>0.05). The complication rates of conservative group, hook plate group and TightRope group were 6.4%(2/31), 11.4%(4/35) and 5.3%(1/19), respectively, with no significant difference(χ~2=0.825, P=0.662). Conclusions For Rockwood type Ⅲ acromioclavicular joint dislocation, all three treatments can obtain satisfactory function results. Modified minimally invasive TightRope operation can quickly restore joint stability, reduce pain, avoid residual deformities, and improve immediate function, especially suitable for patients with high requirements for beauty and early function.更多还原