Atlas钛缆与钩钢板治疗完全性肩锁关节脱位的前瞻性对照研究

目的]使用双股Arias钛缆和锁骨钩钢板治疗完全性肩锁关节脱位，并对其治疗效果进行比较。方法]采用双股Atlas钛缆和锁骨钩钢板治疗Allman Ⅲ型肩锁关节脱位52例，均为单侧。其中双股Atlas钛缆组28例，锁骨钩钢板组24例。男38例，女14例，年龄22—65岁，平均38．5岁。新鲜脱位39例，陈旧性13例。钛缆固定采用喙突根部钻孔，从喙突上方偏内1．5cm处的锁骨干孔道中穿过，锁骨钩钢板均为6孔。术中常规作喙锁韧带修补。结果]所有患者均获随访，随访时间6～42个月，平均18．8个月。对2组患者进行术后功能恢复及影像学评价，按照Lazcano标准对术后上肢肌力、肩部疼痛和关节功能进行评定。钩钢板组优14例，良6例，差4例，治疗优良率83％；钛缆组优22例，良5例，差1例，治疗优良率96％，与钩钢板组无显著差异。结论]双股钛缆治疗完全性肩锁关节脱位的效果与锁骨钩钢板相当，且具有术后肩痛发生率低、利于早期功能锻炼的优点，此外钛缆生物相容性佳，可在体内长期存留而不必取出。

Prospective and comparative study of Atlas titanium cable or clavicular hook plate for total acromioclavicular dislocation

Objective]To compare the result of treatment with double bands of Atlas Ti-cable and clavicular hook plate for total acromioclavicular dislocation.Method]Fifty-two total acromioclavicular dislocation were treated with two different fixation.1)by double bands of Atlas cable(DC group,28 cases) and 2)clavicular hook plate(HP group,24 cases).There were 38 males and 14 females,39 acute and 13 chronic,all unilateral.The mean age of patients was 38.5 years(22~65).A sling of double cable was fixed through the base of the coracoid process and the clavicle at 1.5 cm upper medially above coracoid process.All hook plate were 6 holes.Coracoclavicular ligament was reconstructed routinely.Result]All patients were available for an average duration of follow-up of 18.8 months(range,6~42 months).The results were evaluated by radiographic measurement and clinical recovery(muscle strength in upper arms,pain in shoulder,range of joint motion) by Lazcano standard.In HP group,14 patients were assessed as good,6 as fair and 4 as poor(good and fair 83%).In DC group,22 patients were assessed as good,5 as fair and 1 as poor(good and fair 96%).There was no statistical difference between the two groups.Conclusion]In the treatment of acromioclavicular dislocation,fixation of double bands of Atlas cable is believed to be as good as hook plate fixation.Meanwhile,Atlas cable is featured with less pain followed operation,which in favor of early exercise.For it's good biocompatibility,titanium cable can be retained in body and does not need to be removed.