Tight Rope联合锚钉固定与单纯Tight Rope固定治疗重度肩锁关节脱位的效果比较

目的 比较Tight Rope联合锚钉固定与单纯Tight Rope固定治疗重度肩锁关节脱位的临床效果。方法 回顾性研究。纳入2017年4月—2020年12月南京医科大学附属逸夫医院骨科收治的45例重度肩锁关节脱位患者临床资料,其中男30例、女15例,年龄25~61（47.8±10.5）岁。按照Rockwood分型：Ⅳ型31例,Ⅴ型14例。根据患者手术方法不同分为2组,采用Tight Rope联合锚钉固定治疗25例为Tight Rope+锚钉组,其中男17例、女8例,年龄25~60（48.1±9.9）岁;采用单纯Tight Rope固定治疗20例为Tight Rope组,其中男14例、女6例,年龄27~61（47.4±10.8）岁。比较2组患者临床基线资料、手术切口长度、手术时间、住院时间,以及术后伤口感染、关节活动受限、内固定松动等并发症发生情况。术后3个月,采用疼痛视觉模拟评分法（VAS）评价患肢疼痛程度,应用Constant-Murley评分（CMS） 、美国加州大学洛杉矶分校（UCLA）肩关节评分系统评价肩关节功能;同时拍摄肩关节正位及改良Alexander位X线片,评定锁骨的垂直稳定程度和水平稳定程度。结果 2组患者年龄、性别、受伤部位、受伤原因、受伤至手术时间等基线资料比较差异均无统计学意义（P值均>0.05）。2组患者均顺利完成手术,术中无相关并发症发生。2组手术切口长度、手术时间、住院时间差异均无统计学意义（P值均>0.05）。Tight Rope+锚钉组1例患者术后出现切口愈合不良,予相应处理后愈合良好。45例患者术后均获随访,随访时间6~26个月。随访期间2组患者均无关节活动受限、内固定松动等并发症发生。术后3个月,Tight Rope+锚钉组患肢疼痛VAS评分低于Tight Rope组,CMS评分、UCLA评分均高于Tight Rope组,差异均有统计学意义（t=2.96、14.16、18.26,P值均<0.01）。术后3个月影像学评估锁骨的垂直稳定程度,Tight Rope+锚钉组优20例、良5例,优良率为100.0％（25/25）,Tight Rope组优10例、良8例、差2例,优良率为90.0％（18/20）,差异无统计学意义（χ²=2.62,P=0.106）;锁骨的水平稳定程度,Tight Rope+锚钉组优20例、良5例,优良率100.0％（25/25）,Tight Rope组优5例、良10例、差5例,优良率75.0％（15/20）,Tight Rope+锚钉组优良率高于Tight Rope组,差异有统计学意义（χ²=7.03,P=0.008）。结论 Tight Rope固定联合锚钉固定治疗重度肩锁关节脱位效果可靠,可有效减少术后的疼痛,提高锁骨的水平稳定程度和肩关节功能。

Comparison of Tight Rope augmentation of anchor fixation and Tight Rope fixation in the treatment of severe acromioclavicular dislocation

Objective This study aimed to compare the clinical effects of Tight Rope combined with anchor fixation and Tight Rope fixation on severe acromioclavicular dislocation. Methods A retrospective study was conducted, using the clinical data of 45 patients admitted to the Department of Orthopedics, Sir Run Run Hospital affiliated to Nanjing Medical University from April 2017 to December 2020 because of severe acromioclavicular dislocation. The patients were composed of 30 males and 15 females, aged 25-61 (47.8±10.5) years. According to Rockwood classification, 31 cases were type Ⅳ, and 14 cases were Type Ⅴ. Patients were divided into two groups according to different surgical methods. Twenty-five patients were treated with Tight Rope combined with anchor fixation, composed of 17 males and eight females and aged 25-60 (48.1±9.9) years. Twenty Tight Rope patients were treated with Tight Rope alone, composed of 14 males and six females and aged 27-61 (47.4±10.8) years. The clinical baseline data, surgical incision length, surgical duration, length of hospital stay, postoperative wound infection, joint mobility limitation, loosening of internal fixation, and other complications were compared between the two groups. Three months after surgery, the degree of pain in the affected limb was evaluated with the visual analog scale (VAS) score, and shoulder function was evaluated with the Constant-Murley Score (CMS) and University of California at Los Angeles (UCLA) shoulder scoring system. The vertical and horizontal stability of the clavicle was evaluated with orthographic and modified Alexander radiographs 3 months after the operation. Results No statistically significant differences were found in the baseline data of age, gender, injury site, injury cause, and injury to operation time between the two groups (all P values > 0.05). Patients in both groups successfully completed surgery, and no related complications occurred during surgery. No significant differences in surgical incision length, surgical duration, and hospital stay between the two groups (all P values > 0.05). One patient in Tight Rope + anchor group experienced delayed wound healing, and the wound was healed after corresponding treatment. All 45 patients were followed up for 6-26 months. During the follow-up period, no complications, such as joint movement limitation and internal fixation loosening, were found. Three months after surgery, the VAS score of the Tight Rope + anchor group was lower than that of the Tight Rope group, the CMS and UCLA scores were higher than those of the Tight Rope group, and the differences were statistically significant (t=2.96, 14.16, 18.26; all P values < 0.01). Three months after surgery, the vertical stability of the clavicle was evaluated by imaging. In the Tight Rope + anchor group, 20 cases were excellent, and five cases were good, with an excellent or good rate of 100.0% (25/25). In the Tight Rope group, 10 excellent cases, eight good cases, and two poor cases were found, and a rate of 90.0% (18/20) was obtained. No significant difference was found between the two groups (χ²=2.62,P=0.106). The horizontal stability of the clavicle was excellent in 20 cases and good in five cases in the Tight Rope + anchor group, and the good/good rate was 100.0% (25/25). In the Tight Rope group, five were excellent, 10 were good, and five were poor, with an excellent/good rate of 75.0% (15/20). The good rate of the Tight Rope + anchor group was higher than that of the Tight Rope group, and the difference was statistically significant (χ²=7.03, P=0.008). Conclusion Tight Rope fixation combined with anchor fixation is reliable in the treatment of severe acromioclavicular dislocation and can effectively reduce postoperative pain and improve the level of clavicle stability and shoulder function.