通过回顾性研究比较锁骨钩板与带袢钛板治疗Rockwood Ⅲ、Ⅳ型肩锁关节脱位的临床疗效。

纳入2020年3月至2023年3月于唐山市第二医院和唐山市人民医院接受锁骨钩板或者带袢钛板治疗的Rockwood Ⅲ、Ⅳ型患者共55例，对患者的手术时间、关节功能评分、术后疼痛和并发症方面进行对比。

带袢钛板组平均手术时间为（61.67±6.60）min，显著长于钩板组（38.51±5.61）min（P<0.05）。术后视觉模拟评分方面，带袢钛板组为（2.07±1.14）分，高于钩板组的（1.20±0.96）分（P<0.05）。肩关节功能评估显示，带袢钛板组在前屈上举（142.16° vs 137.22°）和外展上举（142.71° vs 106.31°）活动度方面均显著优于钩板组（P<0.05）。Constant-Murley评分带袢钛板组（89.86±4.41）分明显高于钩板组（73.43±6.63）分（P<0.05）。并发症方面，带袢钛板组出现1例复位丢失，钩板组发生2例肩峰下撞击和3例肩峰下溶解，组间差异具有统计学意义（P<0.05）。两组术中出血量无显著差异，带袢钛板组（57.10±6.11）ml，钩板组（53.90±5.57）ml，P>0.05。

带袢钛板手术方法治疗Rockwood Ⅲ、Ⅳ型肩锁关节脱位在临床疗效中优于锁骨钩板手术方法。

Acromioclavicular joint dislocation (AC dislocation) is a common bone and joint injury in clinical practice, with an annual incidence rate of 18 per 10,000. It is more prevalent in men aged 20 to 39. Traffic accidents and sports activities are the main causes of the disease. The trauma mechanism is the injury of the coracoclavicular ligament caused by the direct or indirect stress transmission of the shoulder to the acromioclavicular joint. This then leads to dislocation of the acromioclavicular joint and the loss of its normal anatomical alignment structure. Most patients with acromioclavicular joint dislocation require surgical treatment. Currently, the main surgical methods are clavicular hook plate internal fixation and titanium plate internal fixation with loops. The clavicular hook plate is a classic surgical treatment method. Its principle is to restore the normal anatomical alignment of the acromioclavicular joint through open reduction, and then place the hook plate under the acromion. The upward displacement of the clavicular side is corrected and fixed through the lever principle. Based on the long-term follow-up results, Liu Zhenhuang, Zhou Haibing, Hu Yongbin et al. believe that the hook plate remains an effective surgical method for treating acromioclavicular joint dislocation. However, compared with other methods, the clinical effect of clavicular hook plate surgery is associated with complications such as subacromial synovitis, subacromial impaction, and subacromial surface wear. The Fixation of titanium plates with loops is Elastic Fixation. Its main therapeutic principle is to use loops and high-intensity risks to restore the stability of the coracoclavicular ligament and thereby maintain the reduction of the acromioclavicular joint. This surgical procedure can be performed under arthroscopy or, under the surveillance of image enhancement, through small incisions around the coracoid process for reduction and fixation. The results of the clinical report show that it has the advantages of small surgical trauma, reliable fixation, simple operation, and no need for secondary removal of internal fixation. Of course, titanium plates with loops also have complications such as bone tract fractures and loss of reduction. At present, there is still controversy over the clinical efficacy comparison of the two surgical methods in Rockwood type Ⅲ and type Ⅳ.

To compare the clinical efficacy of clavicular hook plates and titanium plates with loops in the treatment of Rockwood typeⅢ andⅣ acromioclavicular joint dislocation through a retrospective study.

A total of 55 patients with Rockwood type Ⅲ and Ⅳ who received clavicular hook plate or titanium plate with loop treatment at Tangshan Second Hospital and Tangshan People's Hospital from March 2020 to March 2023 were included. The operation time, joint function score, postoperative pain and complications of the patients were compared.

The average operation time of the loop titanium plate group was (61.67±6.60) minutes, which was significantly longer than that of the hook plate group (38.51±5.61) minutes (P<0.05). In terms of the postoperative VAS score, the group of the titanium plate with loops was (2.07±1.14) points, which was higher than that of the hook plate group (1.20±0.96) points (P<0.05). The assessment of shoulder joint function showed that the titanium plate with loops group with loops was significantly superior to the hook plate group in terms of range of motion in both forward flexion and elevation (142.16° vs 137.22°) and abduction and elevation (142.71° vs 106.31°) (P<0.05). The Constant-Murley score of the titanium plate with loops group (89.86±4.41) points was significantly higher than that of the hook plate group (73.43±6.63) points (P<0.05). In terms of complications, one case of reduction loss occurred in the titanium plate group with loops, while two cases of subacromial impaction and three cases of subacromial dissolution occurred in the hook plate group. The differences between the groups were statistically significant (P<0.05). There was no significant difference in intraoperative blood loss between the two groups [titanium plate with loops group (57.10±6.11) ml, hook plate group (53.90±5.57) ml, P>0.05].

The surgical method with loop titanium plate for treating Rockwood type Ⅲ and Ⅳ acromioclavicular joint dislocation is superior to the hook plate surgical method in clinical efficacy.