内镜下带襻双钛板Tight Rope固定治疗肩锁关节脱位的临床疗效分析

目的 探讨关节镜辅助带襻双钛板(Tight Rope)置入内固定治疗肩锁关节脱位的疗效。 方法 选择40例肩锁关节脱位病人作为研究对象，RockwoodⅢ型27例，Ⅳ型13例。其中20例采用关节镜辅助Tight Rope内固定治疗，设为观察组；20例采用切开复位锁骨钩钢板内固定治疗，设为对照组，均随访24个月以上。记录2组病人的手术相关指标及并发症情况，比较术前、术后1个月、24个月肩关节系统(UCLA)评分、疼痛视觉模拟(VAS)评分、Constant-Murley肩关节评分，术后24个月末参照UCLA评分评估综合疗效。 结果 观察组平均失血量、住院时间均低于对照组，差异有统计学意义(P < 0.01), 2组手术时间差异无统计学意义(P>0.05)；2组术后1个月、24个月疼痛VAS评分均低于术前，UCLA评分、Constant-Murley评分均高于术前，差异均有统计学意义(P < 0.05~P < 0.01)；术前2组VAS评分、UCLA评分和Constant-Murley评分差异无统计学意义(P>0.05)，观察组术后1个月UCLA评分、Constant-Murley评分，术后24个月UCLA评分高于对照组，差异均有统计学意义(P < 0.01)；术后24个月，2组手术疗效优良率、并发症发生率差异无统计学意义(P>0.05)。 结论 关节镜辅助Tight Rope内固定治疗肩锁关节脱位能牢固固定脱位肩锁关节，降低疼痛症状，改善关节功能，且具有创伤小、并发症率低等优点。

Clinical effect analysis of double titanium plate with loop Tight Rope fixation under endoscopy in the treatment of acromioclavicular joint dislocation

Objective To study the effects of double titanium plate with loop(Tight Rope) fixation under endoscopy in the treatment of acromioclavicular joint dislocation. Methods Forty acromioclavicular joint dislocation patients included 27 cases of Rockwood type Ⅲ and 13 cases of type Ⅳ. Twenty cases treated with Tight Rope internal fixation under arthroscopy and 20 cases treated with open reduction and clavicular hook plate internal fixation were divided into the observation group and control group, respectively. Two groups were followed up for more than 24 months. The surgical indicators and complications in two groups were recorded. The comprehensive efficacy in two groups before operation, after 1 and 24 months of operation were evaluated using the shoulder joint system(UCLA), pain visual analogue(VAS) score and Constant-Murley shoulder score. Results The average blood loss and hospital stay in observation group were significantly lower than that in control group(P < 0.01), and the difference of the operation time between two groups was not statistically significant(P>0.05). The pain VAS scores in two groups after 1 and 24 months of surgery were lower than that before surgery, and the UCLA and Constant-Murley scores were higher than those before surgery(P < 0.05 to P < 0.01). The differences of the UCLA and Constant-Murley scores between two groups before operation were not statistically significant(P>0.05). The UCLA score and Constant-Murley score after 1 month of operation, and UCLA score after 24 months of operation in observation group were higher than those in control group(P < 0.01). The differences of the excellent and good rate of operation and in cidence rate of complications between two groups after 24 months of operation were not statistically significant(P>0.05). Conclusions The double titanium plate with loop fixation under endoscopy in the treatment of acromioclavicular joint dislocation can firmly fix the dislocated acromioclavicular joint, reduce pain symptoms and improve joint function, and also has the advantages of small trauma and low complication rate.