保守治疗与锁骨钩钢板内固定手术治疗Rockwood Ⅲ型肩锁关节脱位的中长期疗效对比研究

目的通过对比评估分析保守治疗与锁骨钩钢板内固定手术治疗Rockwood Ⅲ型肩锁关节脱位的中长期临床疗效，为临床上该类型肩锁关节脱位的治疗方式的选择提供依据。 方法回顾性分析自2015年9月至2016年9月在中山市中医院关节科诊治为Roockwood Ⅲ型肩锁关节脱位的患者，入选72例，成功随访47例，采用锁骨钩钢板内固定治疗（钩钢板组）23例、采用保守治疗方法（保守治疗组）24例。随访观察比较两组术后（损伤后）1年、3年、5年视觉模拟评分法（visual analogu scale,VAS）、肩关节功能评分以及并发症发生率。 结果术后1年随访锁骨钩钢板组VAS评分稍优于保守治疗组，但两组差异无统计学意义（P>0.05）；而术后3年以及5年锁骨钩钢板组VAS评分均明显优于保守治疗组，且差异具有统计学意义（P<0.05）。术后1年、3年以及5年随访锁骨钩钢板组肩关节功能评分均明显优于保守治疗组，且差异具有统计学意义（P<0.05）；锁骨钩钢板组并发症发生率明显低于保守治疗组，且差异具有统计学意义（P<0.05）。 结论采用锁骨钩钢板内固定手术治疗Rockwood Ⅲ型肩锁关节脱位，治疗效果较好，是治疗肩锁关节Rockwood Ⅲ型肩锁关节脱位较好的方法。

Comparative Study of long-term and mid-term effects of conservative treatment and internal fixation with clavicular hook plate for Rockwood III acromioclavicular dislocation

BackgroundAcromioclavicular dislocation is a common shoulder injury in clinical joint surgery, accounting for about 2%-12% of all joint dislocations. The injury mechanism is mainly caused by violence on the acromion, resulting in the acromioclavicular ligament and coracoclavicular ligament injury through stress conduction. According to Rockwood classification widely used in the clinic, conservative treatment can be considered for type I and II acromioclavicular dislocations, and surgical treatment can be adopted for type IV, V, and VI. At the same time, there is still controversy in the clinical treatment of Rockwood type III acromioclavicular dislocation with coracoclavicular ligament and acromioclavicular ligament rupture. At present, studies have shown that Rockwood III acromioclavicular joint dislocation by adopting conservative treatment and internal fixation can obtain an excellent short-term curative effect. In contrast, conservative treatment can get short-term curative effects. However, with time and the movement of the shoulder joint, the possibility of further the acromioclavicular joint dislocation. For internal fixation of clavicular hook plate as the most commonly used internal fixation operation, removal of hook plate is often required 6 months after surgery. Whether the acromioclavicular joint is stable compared to the conservative treatment in the long-term curative effect comparison is unclear. Meanwhile, some foreign scholars believe that there is no sufficient evidence to prove that the therapeutic effect of clavicular hook plate is superior to non-surgical treatment. Objective To evaluate the mid and long-term clinical effects of conservative treatment and clavicular hook plate fixation in the treatment of Rockwood type III acromioclavicular dislocation and provide the basis for treatment options. MethodsFrom September 2015 to September 2016, 72 patients with Rockwood type III acromioclavicular dislocation were retrospectively analyzed, and 47 patients were followed up. There were 23 patients treated with clavicular hook plate fixation (clavicular hook plate group) and 24 cases treated with conservative therapy (conservative treatment group) . The incidence of visual analog scale, shoulder function score, and complication rate between the two groups were compared at the 1st, 3rd, and 5th years after the operation. ResultsThe visual analog score of the 1-year follow-up group was slightly better than that of the conservative group, but there was no significant difference between the two groups (P>0.05) . The VAS scores of 3-year and 5-year clavicular hook plate groups were significantly higher than those of the conservative treatment group (P<0.05) , and the shoulder function score (Constant-Murley score) was significantly higher than that of the conservative treatment group. The VAS scores of the clavicular hook plate group in the 1st, 3rd, and 5th years were considerably better than those of the conservative treatment group (P<0.05) . The complication rate of the clavicular hook plate group was significantly lower than that of the conservative treatment group (P<0.05) . ConclusionInternal fixation with clavicular hook plate is an effective method for treating Rockwood type III acromioclavicular joint dislocation.