CAJ | 학술논문

目的探讨采用喙锁韧带重建联合钩钢板固定或缝合锚固定治疗肩锁关节脱位的疗效.方法自2007年2月至2010年4月,将RockwoodⅢ型以上肩锁关节脱位并符合纳入排除标准的105例患者随机分为钩钢板固定组(54例)和缝合锚固定组(51例),分别应用双股掌长肌腱重建喙锁韧带联合钩钢板或缝合锚固定治疗.定期随访患者,在X线片上测量肩锁间距和喙锁间距,末次随访应用Karlsson评分和Constant-Murley评分评估手术疗效.等级资料应用x2检验、计量资料应用两样本t检验分析.结果 16例患者失访,89例患者获得随访,随访时间24 ～ 42个月,平均30个月.其中钩钢板固定组46例,缝合锚固定组43例,两组患者在年龄、性别、损伤侧别、受伤至手术时间和Rockwood分型方面具有可比性.两组肩锁间距和喙锁间距比较,术后6个月内差异无统计学意义(P＞0.05),术后24个月钩钢板固定组明显大于缝合锚固定组(F=1.904和1.854,P＜0.05)；钩钢板固定组术后24个月肩锁间距和喙锁间距均大于其6个月测量数据(F=1.863和1.842,P＜0.05).末次随访Constant-Murley评分钩钢板固定组平均88.5分低于缝合锚固定组的平均92.7分(F =0.475,P=0.017).Karlsson评分缝合锚固定组患者功能优良率为95.4％,明显优于钩钢板固定组的80.5％ (x2 =4.564,P=0.033).结论喙锁韧带重建结合缝合锚固定治疗肩锁关节脱位患者疗效优于喙锁韧带重建结合钩钢板固定.钩钢板固定取出后,肩锁间距和喙锁间距显著增加,可能与其疗效较差有关.
목적 탐토채용훼쇄인대중건연합구강판고정혹봉합묘고정치료견쇄관절탈위적료효.방법 자2007년2월지2010년4월,장RockwoodⅢ형이상견쇄관절탈위병부합납입배제표준적105례환자수궤분위구강판고정조(54례)화봉합묘고정조(51례),분별응용쌍고장장기건중건훼쇄인대연합구강판혹봉합묘고정치료.정기수방환자,재X선편상측량견쇄간거화훼쇄간거,말차수방응용Karlsson평분화Constant-Murley평분평고수술료효.등급자료응용x2검험、계량자료응용량양본t검험분석.결과 16례환자실방,89례환자획득수방,수방시간24 ～ 42개월,평균30개월.기중구강판고정조46례,봉합묘고정조43례,량조환자재년령、성별、손상측별、수상지수술시간화Rockwood분형방면구유가비성.량조견쇄간거화훼쇄간거비교,술후6개월내차이무통계학의의(P＞0.05),술후24개월구강판고정조명현대우봉합묘고정조(F=1.904화1.854,P＜0.05)；구강판고정조술후24개월견쇄간거화훼쇄간거균대우기6개월측량수거(F=1.863화1.842,P＜0.05).말차수방Constant-Murley평분구강판고정조평균88.5분저우봉합묘고정조적평균92.7분(F =0.475,P=0.017).Karlsson평분봉합묘고정조환자공능우량솔위95.4％,명현우우구강판고정조적80.5％ (x2 =4.564,P=0.033).결론 훼쇄인대중건결합봉합묘고정치료견쇄관절탈위환자료효우우훼쇄인대중건결합구강판고정.구강판고정취출후,견쇄간거화훼쇄간거현저증가,가능여기료효교차유관.
Objective To investigate the clinical outcomes of acromioclavicula (AC) joint dislocation treated with coracoclavicular (CC) ligament reconstruction and hook plate fixation/suture-anchor fixation.Methods There were 105 patients with Rockwood type Ⅲ or severer AC joint dislocations were randomly divided into two groups from February 2007 to April 2010.They were treated with CC ligament reconstruction using double bundle of Palmaris longus (hook plate fixation group,54 cases),and subsequently fixed with hook plates or suture-anchors (suture-anchors group,51 cases).Patients were followed up,and the AC distance and CC distance were measured on the postoperative X-ray films,and the outcomes were assessed according to Karlsson criteria and Constant-Murley shoulder score.Ranked data was analyzed with the use of x2 test and measurement data with two sample t test.Results Eighty-nine patients were followed up for 24-42 months,average 30 months.There were 46 cases in hook plate fixation group and 43 cases in suture-anchor fixation group,without significant difference in age,gender,injured side and Rockwood classification between both groups.Between the two groups,no statistical difference was detected in the AC and CC distance measured within 6 months after operation (P ＞ 0.05).The AC and CC distances of hook plate fixation group measured in 24 months postoperatively were larger than those in suture-anchor fixation group,respectively (F =1.904 and 1.854,P ＜ 0.05).In hook plate fixation group,the AC and CC distances measured in 24 months postoperatively were larger than those measured in 6 month postoperatively,respectively(F =1.863 and 1.842,P ＜ 0.05).According to Constant-Murley shoulder score,the average score was 88.5 for hook plate fixation group and 92.7 for suture-anchor fixation group (F=0.475,P =0.017).According to Karlsson criteria,the excellent and good rate of the functional recovery was 95.4％ in suture-anchor fixation group,better than hook plate fixation group (x2 =4.564,P =0.033).Conclusions The clinical outcomes of AC joint dislocation treated with CC ligament reconstruction and suture-anchor fixation are better than those treated with CC ligament reconstruction and hook plate fixation.The AC and CC distances increase after the removal of hook plate,which may be associated with poor functional recovery.