关节镜下同种异体肌腱重建喙锁韧带与锁骨钩钢板固定治疗肩锁关节脱位的疗效对比

Comparative study on the effect of coracoclavicular ligament reconstruction with allogeneic tendon under arthroscope and clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation

摘要:

目的 比较关节镜下同种异体肌腱重建喙锁韧带与锁骨钩钢板固定治疗肩锁关节脱位的临床疗效。方法 选取110例完全性肩锁关节脱位的患者随机分成两组，治疗组（n = 55）采用关节镜下同种异体肌腱重建喙锁韧带治疗，对照组（n = 55）采用锁骨钩钢板固定。比较两组患者的疗效、手术指标及喙锁间距。结果 治疗组美国肩肘外科医师协会评分（ASES）和优良率明显高于对照组，固定对照组钢板取出后肩关节功能明显优于钢板取出前（P < 0.05）。治疗组休息、活动时疼痛明显轻于对照组（P < 0.05）。对照组疼痛主要集中在活动时，在钢板取出后疼痛明显减轻。治疗组手术时间、平均住院时间和末次随访时喙锁间距明显较对照组短，手术出血量明显较对照组少（均P < 0.05）。两组患者并发症比较，差异无统计学意义（P > 0.05）。结论 与锁骨钩钢板固定相比，关节镜下同种异体肌腱重建喙锁韧带治疗肩锁关节脱位具有创伤小、疼痛轻和功能恢复快的优势。

Abstract:

Objective To compare the clinical effects of coracoclavicular ligament reconstruction with allogeneic tendon and clavicular hook plate in the treatment of acromioclavicular joint dislocation under arthroscope.Methods 110 patients with complete acromioclavicular joint dislocation were divided into two groups. The treatment group (n = 55) was treated with arthroscopic coracoclavicular ligament reconstruction with allogeneic tendons, and the control group (n = 55) was fixed with clavicular hook plate fixation. The curative effect, operation indicators and the distance between the coracoid lock were compared between the two groups.Results The American Shoulder and Elbow Surgeons (ASES) score and excellent and good rate of the treatment group were significantly higher than those of the control group, and the improvement of shoulder joint function in the control group after the plate was removed was better than that before the plate was removed (P < 0.05). The pain during rest and activity in the treatment group was significantly less than that in the control group (P < 0.05). The pain in the control group was mainly concentrated during exercise, and the pain was significantly reduced after the steel plate was taken out. The operation time, average hospital stay and distance between the coracoid lock at the last follow-up in the treatment group were shorter than those in the control group, the operative blood loss in the treatment group was less than that in the control group (all P < 0.05). There was no statistical difference in complications between the two groups (P > 0.05).Conclusion Compared with clavicular hook plate fixation, arthroscopic allogeneic tendon reconstruction of the coracoclavicular ligament to treat acromioclavicular joint dislocation has the advantages of less trauma, less pain, and faster functional recovery.