急性肩锁关节脱位Rockwood Ⅲ~Ⅴ型手术治疗中锁骨钩钢板和袢钢板应用效果的比较分析

目的比较急性肩锁关节脱位Rockwood Ⅲ ~ Ⅴ型手术治疗中锁骨钩钢板和袢钢板应用效果。 方法选取2013年3月至2018年3月上海市同仁医院收治的急性肩锁关节脱位患者93例，依据手术过程中使用的钢板类型将患者分成两组，锁骨钩组（n=42）应用锁骨钩钢板，袢钢板组（n=51）应用袢钢板。观察比较两组的相关手术指标水平；比较术前、术后的视觉模拟评分（visual analogue scale/score，VAS）及肩关节功能Constant-Murley评分变化情况；比较两组手术后的不良并发症发生情况。 结果袢钢板组切口长度短于锁骨钩组（P<0.05），袢钢板组手术时间长于锁骨钩组（P<0.05），袢钢板组术中出血量低于锁骨钩组（P<0.05），袢钢板组恢复工作时间短于锁骨钩组（P<0.05）；手术前两组VAS评分差异无统计学意义（P>0.05），手术后两组的VAS评分较治疗前均显著升高，但袢钢板组VAS评分低于锁骨钩组（P<0.05）；手术前两组Constant-Murley评分差异无统计学意义（P>0.05），手术后袢钢板组Constant-Murley评分显著高于锁骨钩组（P<0.05），袢钢板组基本无肩关节功能丢失，钩钢板外展受限明显；锁骨钩组并发症发生率显著高于袢钢板组（P<0.05）。 结论对急性肩锁关节脱位Rockwood Ⅲ～Ⅴ型患者进行手术治疗的过程中，两种类型的钢板都能使患者的肩关节功能得到有效恢复。袢钢板组患者手术切口、术中出血量、术后疼痛评分及并发症发生率更低；锁骨钩组手术时间更短，应综合患者的实际情况来进行选择。

Comparative analysis of the application of clavicular hook plate versus loop plate in the treatment of Rockwood type III-V acute acromioclavicular dislocation

BackgroundAcromioclavicular joint dislocation is one of the most common shoulder injuries in clinical orthopedics which mainly occurs in young adults, accounting for about 12% of all shoulder injuries in clinical practice. There are various types of fixation methods in the treatment of acromioclavicular joint dislocation, including plate and screw fixation, Kirschner wire and tension band fixation, etc., and there are also numerous types of plates. There has been a lot of controversy in clinical practice about which type of plate is the best treatment for patients with acromioclavicular dislocation. Objective To investigate and compare the application effect of clavicular hook plate versus loop plate in the surgical treatment of acute acromioclavicular dislocation of Rockwood type Ⅲ-Ⅴ. MethodsFrom March 2013 to March 2018, 93 patients with acute acromioclavicular dislocation were admitted into our hospital. According to the types of plate used in the surgical procedures, the patients were selected and divided into two groups, clavicular hook plate group (n=42) and loop plate group (n=51) . The surgical characters of the two groups was observed and compared. The changes in visual analogue scale (VAS) scores and Constant-Murley scores before and after surgery in both groups were recorded as well as the incidence of postoperative adverse complications. ResultsThe incision length in the loop plate group was shorter than that in the clavicular hook plate group (P<0.05) . The operation time in the loop plate group was longer than that in the clavicular hook plate group (P<0.05) . The intraoperative blood loss in the loop plate group was lower than that in the clavicular hook plate group (P<0.05) . The recovery time in the loop plate group was shorter than that in the clavicular hook plate group (P<0.05) . Before surgery, there was no significant difference in VAS scores between the two groups (P>0.05) . After surgery, VAS scores of the two groups was significantly higher than that before treatment, but the VAS score of loop plate group was lower than that in the clavicular hook plate group (P<0.05) . Before surgery, there was no significant difference in the Constant-Murley scores between the two groups (P>0.05) . After surgery, the Constant-Murley score in the loop plate group was significantly higher than that in the clavicular hook plate group (P<0.05) . The incidence of complications in the clavicular hook plate group was significantly higher than that in the loop plate group (P<0.05) . ConclusionsDuring the surgical treatment, both types of plates can effectively restore the shoulder function in patients with acute acromioclavicular dislocation of Rockwood type III-V. The loop plate group had shorter incisions, lower intraoperative blood loss, postoperative VAS score as well as complication rate. The clavicular hook plate group had lower operation time and recovery time. Thus, the selection should be made based on the actual situation of the patients.