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中华肩肘外科电子杂志 ›› 2020, Vol. 08 ›› Issue (03) : 209 -214. doi: 10.3877/cma.j.issn.2095-5790.2020.03.004

所属专题: 文献

论著

两种不同锁骨钩置钩法在Rock-Wood Ⅲ、Ⅳ、Ⅴ型肩锁关节脱位治疗中的比较分析
刘俊1, 危蕾1, 吴波1, 廖苏平1, 邢丹谋1,()   
  1. 1. 430033 武汉市第四医院手外科
  • 收稿日期:2020-04-30 出版日期:2020-08-05
  • 通信作者: 邢丹谋
  • 基金资助:
    武汉市卫生计生委科研项目(WZ1805)

Comparative analysis of two different hook placement methods in the treatment of Rockwood typeⅢ, Ⅳ andⅤ acromioclavicular joint dislocations

Jun Liu1, Lei Wei1, Bo Wu1, Suping Liao1, Danmou Xing1,()   

  1. 1. Department of Handsurgy, Wuhan Fourth Hospital, Wuhan 430033, China
  • Received:2020-04-30 Published:2020-08-05
  • Corresponding author: Danmou Xing
  • About author:
    Corresponding auther:Xing Danmou,Email:
引用本文:

刘俊, 危蕾, 吴波, 廖苏平, 邢丹谋. 两种不同锁骨钩置钩法在Rock-Wood Ⅲ、Ⅳ、Ⅴ型肩锁关节脱位治疗中的比较分析[J]. 中华肩肘外科电子杂志, 2020, 08(03): 209-214.

Jun Liu, Lei Wei, Bo Wu, Suping Liao, Danmou Xing. Comparative analysis of two different hook placement methods in the treatment of Rockwood typeⅢ, Ⅳ andⅤ acromioclavicular joint dislocations[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2020, 08(03): 209-214.

目的

比较分析两种不同锁骨钩置钩方法在治疗Rock-Wood Ⅲ、Ⅳ、Ⅴ型肩锁关节脱位治疗中的临床效果。

方法

将本研究纳入的48例患者按治疗方式不同分为两组:采用常规置钩方式治疗24例(常规组),其中男17例、女7例,平均年龄42.4岁;采用改进置钩法治疗24例(改进组),其中男16例、女8例,平均年龄44.7岁。通过对比常规组及改进组不同置钩方法对Rock-Wood Ⅲ、Ⅳ、Ⅴ型肩锁关节脱位的治疗,比较两组在肩锁间隙、喙锁间隙的差别,并进行视觉模拟评分(visual analogue scale,VAS)及肩部功能的Constant评分。

结果

所有患者获得平均13.4个月随访,改进组术后喙锁间隙与常规组术后无明显差别,在肩锁间隙上两组有明显差别,改进组在VAS及Constant评分优于常规组。

结论

改进后的置钩在治疗肩锁关节脱位上与常规方法相比固定更为稳定,在减小术后肩锁关节增宽、控制肩锁关节前后移位方面有其优势,为应用锁骨钩钢板治疗Rock-Wood Ⅲ、Ⅳ、Ⅴ型肩锁关节脱位提供了新的思路。

Background

Acromioclavicular dislocation is one of the common dislocations in clinical practice, accounting for about 6% of total joint dislocations and 12% of shoulder injuries.

Objective

To compare and analyze the clinical effect of two different clavicular hook placement methods in the treatment of Rockwood typeⅢ,Ⅳ andⅤ acromioclavicular dislocations.

Methods

By comparing the treatment of Rockwood typeⅢ,Ⅳ andⅤ acromioclavicular joint dislocation with two different hook placement methods in the conventional group and the improved group, the differences in the acromioclavicular space and coracoclavicular space were compared between the two groups, and the VAS scores and Constant scores were compared as well.

Results

All patients were followed up for an average of 13.4 months. There was no statistical difference in the coracoclavicular space between two groups. There were significantly statistical difference in the acromioclavicular space between two groups. The improved group was better in the VAS scores and Constant scores than that of conventional group.

Conclusions

Compared with the conventional method, the improved hook placement is more stable in the treatment of acromioclavicular dislocation. It has advantages in reducing the postoperative width of acromioclavicular joint and controlling its anteroposterior displacement, which provides a new idea for the application of clavicular hook plate in the treatment of Rockwood type Ⅲ, Ⅳ and Ⅴ acromioclavicular dislocations.

表1 两组患者一般资料比较
图1 术者可根据患者肩锁关节不同深度(12 mm、15 mm、18 mm)进行个性化选择(图A),锁骨钩常规置钩法模型(图B),肩锁关节后外侧开孔模拟(图C),改进置钩法置入锁骨钩模型(图D)
图2 PACS系统测量肩锁间隙及喙锁间隙示意图
图3 典型病例:患者男性,45岁,摔伤肩部致肩锁关节Ⅴ型脱位 图A:后前位X线片提示肩锁间隙、喙锁间隙增宽明显;图B:CT三维重建图像排除肩峰或喙突等部位骨折;图C:术中发现肩锁韧带及喙锁韧带断裂;图D:肩锁关节脱位复位后克氏针临时固定,在肩锁关节后外侧使用4.5 mm钻头打孔;图E:复位固定完成的肩锁关节;图F:术后肩锁关节正位X线片提示复位良好;图G-I:术后12个月肩关节功能良好
表2 两组患者术前、术后VAS评分的比较(分,±s)
表3 两组患者治疗后肩关节Constant评分比较(分,±s)
表4 两组患者治疗前后肩锁间隙和喙锁间隙的比较(mm,±s)
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