CAJ | 학술논문

背景:目前对Ⅲ型肩锁关节脱位的治疗是行保守治疗还是手术治疗,以及采用何种手术方式治疗,仍存在很大争议.目的:观察锁骨钩板置入治疗RockwoodⅢ型肩锁关节脱位的临床疗效.方法:选择2005-12/2008-06宜昌市夷陵区医院骨科收治的RockwoodⅢ型肩锁关节脱位患者56例,男42例,女14例,年龄16～65岁,平均32岁.均采用锁骨钩钢板置入进行治疗,分别于术前、术后1年取出内固定前、取出内固定后3个月采用目测类比评分、美国肩肘外科医师评分、Constant and Murley评分系统进行评定,比较钢板置入前后患者肩关节功能的变化及有无并发症发生.结果与结论:全部患者均顺利完成手术且获得随访,随访时间15～30个月,平均20个月.均在1年左右取出内固定,行喙锁韧带修复者32例,未行喙锁韧带修复者24例.取出内固定后肩锁关节脱位复发2例,均未行喙锁韧带修复.本组有2例出现肩痛、异物感,无内固定失败病例.术后1年取内固定前目测类比评分较术前降低,ASES、Constant and Murley 评分较术前升高(P＜0.01);取内固定后3个月目测类比评分较术后1年取内固定前降低,ASES、Constant and Murley评分较术后1年取内固定前升高(P＜0.05).提示锁骨钩板置入治疗RockwoodⅢ型肩锁关节脱位,操作简单,创伤较小,是一种比较理想的内固定.
배경:목전대Ⅲ형견쇄관절탈위적치료시행보수치료환시수술치료,이급채용하충수술방식치료,잉존재흔대쟁의.목적:관찰쇄골구판치입치료RockwoodⅢ형견쇄관절탈위적림상료효.방법:선택2005-12/2008-06의창시이릉구의원골과수치적RockwoodⅢ형견쇄관절탈위환자56례,남42례,녀14례,년령16～65세,평균32세.균채용쇄골구강판치입진행치료,분별우술전、술후1년취출내고정전、취출내고정후3개월채용목측류비평분、미국견주외과의사평분、Constant and Murley평분계통진행평정,비교강판치입전후환자견관절공능적변화급유무병발증발생.결과여결론:전부환자균순리완성수술차획득수방,수방시간15～30개월,평균20개월.균재1년좌우취출내고정,행훼쇄인대수복자32례,미행훼쇄인대수복자24례.취출내고정후견쇄관절탈위복발2례,균미행훼쇄인대수복.본조유2례출현견통、이물감,무내고정실패병례.술후1년취내고정전목측류비평분교술전강저,ASES、Constant and Murley 평분교술전승고(P＜0.01);취내고정후3개월목측류비평분교술후1년취내고정전강저,ASES、Constant and Murley평분교술후1년취내고정전승고(P＜0.05).제시쇄골구판치입치료RockwoodⅢ형견쇄관절탈위,조작간단,창상교소,시일충비교이상적내고정.
BACKGROUND:Which an ideal method to treat type Rockwood Ⅲ acromioclavicular joint dislocation is,traditional or surgical therapy,is still controversial.OBJECTIVE:To investigate the clinical effect of clavicular hook plate implantation on type Rockwood Ⅲ acromioclayicular joint dislocation.METHODS:A total of 56 patients with type Rockwood Ⅲ acromioclavicular joint dislocation were selected from Department of Orthopaedics of Yiling Hospital between December 2005 and June 2008.There were 42 males and 14 females,aged 16-65 years and mean age of 32 years.All patients were treated with clavicular hook plate implantation.Indicators including visual analogue scale (VAS),the United States shoulder and elbow surgeon score (ASES),and Constant and Murley scoring system were tested pre-operatively,one year postoperatively,before internal fixation,and 3 months after internal fixation;additionally,functional changes of the shoulder joint and complications were analyzed before and after clavicular hook plate implantation.RESULTS AND CONCLUSION:The surgery and following-up were successfully achieved in 56 cases.The following-up lasted for 15-30 months,with the mean time of 20 months.The internal fixation was taken out at about 1 year after implantation.Coracoclavicular ligament was repaired in 32 cases but not in the 24 cases.Two patients with acromioclavicular joint dislocation recurrence were excluded,and coracoclavicular ligament therapy was not performed.Shoulder pain,foreign body sensation,and internal fixation failure occurred in two cases.One year after operation,VAS was decreased compared with that before operation,but ASES and Constant and Murley score were significantly increased (P＜0.01).At three months after internal fixation,VAS was decreased compared with that at 1 year after operation,but ASES and Constant and Murley score were increased (P＜0.05).The results demonstrated that clavicular hook plate implantation for treating type Rockwood Ⅲ acromioclavicular joint dislocation is simple and less invasive,thus it is an ideal internal fixation.