关节镜下双钛板AC TightRope与钩钢板内固定治疗新鲜高分型肩锁关节脱位的疗效比较

Comparison of the effects of arthroscopically assisted AC TightRope fixation and hook plate fixation for the treatment of acute high-grade acromioclavicular joint dislocation

摘要:

目的 比较关节镜下双钛板AC TightRope与钩钢板内固定治疗新鲜高分型肩锁关节脱位的疗 效。方法 选取2013年6月—2017年2月在浙江中医药大学附属金华市中医医院就诊的新鲜Rockwood Ⅲ～ Ⅴ型肩锁关节脱位患者69例作为研究对象。应用关节镜下双钛板AC TightRope内固定治疗的27例患者为 TR组；切开复位钩钢板内固定治疗的42例患者为HP组。随访时间>24个月。记录并比较两组并发症情况、 手术前后视觉模拟评分法（VAS）、肩关节Constant-Murley评分、肩关节外展角度、喙锁间隙及住院治疗总 费用；比较两组术后24个月Karlsson分级评定情况。结果 两组总并发症发生率比较，差异无统计学意义 （P >0.05）。两组VAS评分、Constant-Murley评分、肩关节外展角度及喙锁间隙在不同时间、不同组间及变 化趋势上有差别（P <0.05）。两组术后24个月Karlsson分级评定比较，差异无统计学意义（P >0.05）。TR组 住院期间总费用低于HP组（P <0.05）。结论 关节镜下双钛板AC TightRope治疗新鲜高分型肩锁关节脱位 近期疗效优于钩钢板，同时具有无强制性植入物移除的优点。钩钢板固定患者拆除内固定装置后，虽然可明 显提高疗效，但是两次手术创伤较大，且总费用较高。

Abstract:

Objective To compare the therapeutic effects of arthroscopically assisted AC TightRope fixation and hook plate fixation for the treatment of acute high-grade acromioclavicular joint dislocation. Methods A total of 69 patients with acute Rockwood type III - V acromioclavicular joint dislocation were selected, of which 27 patients underwent arthroscopically assisted AC TightRope fixation (TR group) and 42 underwent hook plate fixation (HP group). All patients were followed up for more than 24 months. The complication rate, visual analogue scale (VAS) scores, Constant-Murley scores, shoulder abduction angle, coracoclavicular distance measured by standard X-ray and the total cost of treatment during hospitalization were recorded and compared between the two groups. Overall recovery of the shoulder was assessed by the Karlsson criterion. Results There was no significant difference in overall complication rate between the two groups (P > 0.05). There were significant differences in VAS scores, Constant-Murley scores, shoulder abduction angle, and coracoclavicular distance at different time points as well as the changing trends of these indicators between the two groups (P < 0.05). According to Karlsson criterion, the postoperative efficacy assessed 24 months after the surgery was not significantly different between the two groups (P > 0.05). The total cost during hospitalization in TR group was lower than that in HP group (P < 0.05). Conclusion Arthroscopically assisted AC TightRope fixation for the treatment of acute high-grade acromioclavicular joint dislocation is significantly better than the hook plate fixation in the short run, and it is not necessarily required to remove the implant. The therapeutic efficacy of hook plate fixation can be largely improved after removal of the internal fixation device, but it requires two operations with greater trauma, and the total cost is higher than that of AC TightRope fixation.