肩锁关节脱位不同手术方法疗效比较的病例对照研究

目的:分析比较应用单纯肩锁钩板固定术、单纯喙突移植术及肩锁钩板联合改良肌肉动力移位术3种手术方法治疗肩锁关节全脱位的疗效。方法:自2006年1月至2009年11月分别采用单纯肩锁钩板固定术、单纯喙突移植术及肩锁钩板联合改良肌肉动力移位术3种手术方法治疗肩锁关节全脱位65例。65例肩锁关节全脱位患者被分成3组,采用单纯肩锁钩板固定术组(A组)22例,单纯喙突移植术组(B组)21例,肩锁钩板联合改良肌肉动力移位术组(C组)22例。按照Karlsson评分标准评定术后肩关节功能恢复情况。结果:65例均获得术后随访,时间0.5～3年,平均1.5年。A组取出内固定后有8例发生半脱位,2例发生全脱位并有肩锁关节骨关节炎,1例在术后1年发生锁骨钩板钩部断裂。B组取出内固定后有7例发生半脱位,1例取出内固定物后发生全脱位,5例发生肩锁关节骨关节炎出现严重的疼痛和肩部活动受限。C组取出内固定后有2例发生半脱位,无全脱位及肩锁关节骨关节炎。按照Karlsson评分标准评定:A组优12例,良8例,差2例;B组优9例,良7例,差5例;C组优20例,良2例,差0例。肩锁钩板联合改良肌肉动力移位术组与前两组疗效比较差异有统计学意义(P<0.05)。结论:肩锁关节全脱位采用肩锁钩板联合改良肌肉动力移位术治疗,具有手术操作简便、固定牢固、可早期活动等优点,疗效确切,是一种较好的治疗方法。

Controlled clinical trials on different surgical methods for the treatment of acromioclavicular dislocation

Objective: To compare clinical effects of clavicular hook plate fixation,coracoid transplantation,and clavicular hook plate fixation combined with modified dynamic muscle transfer for the treatment of the complete acromioclavicular dislocation. Methods: From January 2006 to November 2009,65 patients with sustained complete acrominoclavicular dislocation were treated with clavicular hook plate fixation,coracoid transplantation,and clavicular hook plate fixation combined with modified dynamic muscle transfer. All the patients were divided into three groups:22 patients in group A were treated with clavicular hook plate fixation,including 17 males and 5 females,with an average age of(31.0±10.0) years;21 patient in group B were treated with coracoid transplantation,including 16 males and 5 females,with an average age of (33.0±6.4) years;22 patients in group C were treated with clavicular hook plate fixation combinded with modified dynamic muscle transfer,including 18 males and 4 females,with an average age of (30.0±5.3) years. Postoperative functional recovery was evaluated by Karlsson criteria. Results: All the patients were followed up,and the duration ranged from half to three years(averaged 1.5 years). In group A,8 patients got half re-dislocation,2 patients got complete re-dislocation and arthritis of acromioclavicular joint after internal fixations removal,1 patient had clavicular hook plate broken after operation. In group B,7 patients got half re-dislocation,1 patient got complete re-dislocation,and 5 patients had arthritis of acromioclavicular joint with acute pain and limited shoulder function after internal fixations removal. In group C,2 patients got half re-dislocation,no complete re-dislocation and arthritis of acromioclavicular joint occurred after internal fixations removal. According to Karlsson evaluation,in group A,12 patients obtained an excellent result,8 good and 2 poor;in group B,the data were 9,7 and 5 respectively;in group C,they were 20,2 and 0 respectively. There were remarkable differences of therapeutic effects between the clavicular hook plate fixation combined with modified dynamic muscle transfer and that with either of the former two treatment methods (P<0.05). Conclusion: Clavicular hook plate combined with modified dynamic muscle transfer is a reliable and good treatment for the complete acrominoclavicular dislocation,with advantages such as easy to handle,stable fixation and early exercise.