克氏針張力帶與鎖骨鉤鋼板治療RockwoodⅢ型肩鎖關節脫位的療效比較_《華西醫學》

作者：

楊衡 , 王軍 , 張定偉 , 王陶 , 石波 , 康斌 , 劉都

肩鎖關節脫位;克氏針張力帶;鎖骨鉤鋼板;

關鍵詞：

肩鎖關節脫位克氏針張力帶鎖骨鉤鋼板

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目的　比較克氏針張力帶與鎖骨鉤鋼板治療RockwoodⅢ型肩鎖關節脫位的臨床療效。方法　1999年1月－2007年3月，收治肩鎖關節脫位患者29例，分別采用克氏針張力帶聯合喙鎖韌帶重建（克氏針組10例）和鎖骨鉤鋼板（鋼板組19例）治療。其中男18例，女11例；年齡19～50歲，平均38.2歲。患者均為新鮮RockwoodⅢ型肩鎖關節脫位，受傷至手術時間1～16 d，平均3 d。兩組患者性別、年齡、受傷至手術時間等一般資料比較差異無統計學意義（P＞0.05）。進行兩組患者術后臨床及影像學評估比較。結果　25例患者（克氏針組10例，鋼板組15例）獲隨訪，隨訪時間2～12年，平均6年。術后克氏針組發生克氏針彎曲5例、斷裂1例；鋼板組切口淺表感染2例，經換藥后治愈，其余患者切口Ⅰ期愈合。兩組患者肩鎖關節均獲得良好功能，組間比較差異無統計學意義（P＞0.05）。影像學方面：與克氏針組相比，在患肢負重位時鋼板組喙鎖間隙間距增加了23%（P＜0.05），非負重位兩組間距差異無統計學意義（P＞0.05）。術后8～12周出現喙鎖韌帶鈣化，鋼板組12例、克氏針組2例（P＜0.05）。術后6個月出現肩鎖關節骨性關節炎，鋼板組2例、克氏針組1例（P＞0.05）。肩關節功能與影像學結果無相關性（r=0.096，P＞0.05）。結論　克氏針張力帶聯合喙鎖韌帶重建和鎖骨鉤鋼板固定治療RockwoodⅢ型肩鎖關節脫位均可獲得良好的臨床功能。與克氏針張力帶相比，鎖骨鉤鋼板固定具有手術操作簡便、療效確切、并發癥少、能夠早期康復鍛煉等優點。

引用本文： 楊衡,王軍,張定偉,王陶,石波,康斌,劉都. 克氏針張力帶與鎖骨鉤鋼板治療RockwoodⅢ型肩鎖關節脫位的療效比較. 華西醫學, 2012, 27(10): 1446-1449. doi: 復制

1.	Rockwood CJ, Williams G, Young D. Disorders of the acromioclavicular joint[M]// Rockwood CJ, Matsen FA. The Shoulder. 2nd ed. Philadelphia: WB Saunders, 1998: 483-553.
2.	Calvo E, López-Franco M, Arribas IM. Clinical and radiologic outcomes of surgical and conservative treatment of type Ⅲacromioclavicular joint injury[J]. J Shoulder Elbow Surg, 2006, 15(3): 300-305.
3.	Imatani RJ, Hanlon JJ, Cady GW. Acute，complete acromioclavicular separation[J]. J Bone Joint Surg(Am), 1975, 57(3): 328-332.
4.	Constant CR, Murley AH. A clinical method of functional assessment of the shoulder[J]. Clin Orthop Relat Res, 1987, (214): 160-164.
5.	Wollmerstedt N, Faller H, Ackermann H, et al. Evaluation of the Extra Short Musculoskeletal Function Assessment questionnaire XSMFA-D in patients with musculoskeletal disorders and surgical or medical in-patient treatment[J]. Rehabilitation(Stuttg), 2006, 45(2): 78-87.
6.	Taft TN, Wilson FC, Oglesby JW. Dislocation of the acromioclavicular joint. An end-result study[J]. J Bone Joint Surg(Am), 1987, 69(7): 1045-1051.
7.	Salem KH, Schmelz A. Treatment of TossyⅢ acromioclavicular joint injuries using hook plates and ligament suture[J]. J Orthop Trauma, 2009, 23(8): 565-569.
8.	Huang TW, Hsieh PH, Huang KC, et al. Suspension suture augmentation for repair of coracoclavicular ligament disruptions[J]. Clin Orthop Relat Res, 2009, 467(8): 2142-2148.
9.	Leidel BA, Braunstein V, Kirchhoff C, et al. Consistency of long-term outcome of acute Rockwood gradeⅢ acromioclavicular joint separations after K-wire transfixation[J]. J Trauma, 2009, 66(6): 1666-1671.
10.	Flinkkilä T, Ristiniemi J, Hyvönen P, et al. Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation[J]. Acta Orthop Scand, 2002, 73(1): 50-53.
11.	李珠, 梅炯, 吳衛平, 等．不穩定性鎖骨外側端骨折及肩鎖關節脫位的手術治療[J].骨與關節損傷雜志, 2004, 19(6): 367-368.
12.	李欣, 何愛詠.鎖骨鉤鋼板與克氏針張力帶治療肩鎖關節脫位和鎖骨遠端骨折療效比較[J].中國矯形外科雜志, 2006, 14(24): 1855-1857, I0002.
13.	Lyons FA, Rockwood CA Jr. Migration of pins used in operations on the shoulder[J]. J Bone Joint Surg(Am), 1990, 72(8): 1262-1267.
14.	Lemos MJ, Tolo ET. Complications of the treatment of the acromioclavicular and sternoclavicular joint injuries， including instability[J]. Clin Sports Med, 2003, 22(2): 371-385.

1. 　Rockwood CJ, Williams G, Young D. Disorders of the acromioclavicular joint[M]// Rockwood CJ, Matsen FA. The Shoulder. 2nd ed. Philadelphia: WB Saunders, 1998: 483-553.
2. 　Calvo E, López-Franco M, Arribas IM. Clinical and radiologic outcomes of surgical and conservative treatment of type Ⅲacromioclavicular joint injury[J]. J Shoulder Elbow Surg, 2006, 15(3): 300-305.
3. 　Imatani RJ, Hanlon JJ, Cady GW. Acute，complete acromioclavicular separation[J]. J Bone Joint Surg(Am), 1975, 57(3): 328-332.
4. 　Constant CR, Murley AH. A clinical method of functional assessment of the shoulder[J]. Clin Orthop Relat Res, 1987, (214): 160-164.
5. 　Wollmerstedt N, Faller H, Ackermann H, et al. Evaluation of the Extra Short Musculoskeletal Function Assessment questionnaire XSMFA-D in patients with musculoskeletal disorders and surgical or medical in-patient treatment[J]. Rehabilitation(Stuttg), 2006, 45(2): 78-87.
6. 　Taft TN, Wilson FC, Oglesby JW. Dislocation of the acromioclavicular joint. An end-result study[J]. J Bone Joint Surg(Am), 1987, 69(7): 1045-1051.
7. 　Salem KH, Schmelz A. Treatment of TossyⅢ acromioclavicular joint injuries using hook plates and ligament suture[J]. J Orthop Trauma, 2009, 23(8): 565-569.
8. 　Huang TW, Hsieh PH, Huang KC, et al. Suspension suture augmentation for repair of coracoclavicular ligament disruptions[J]. Clin Orthop Relat Res, 2009, 467(8): 2142-2148.
9. 　Leidel BA, Braunstein V, Kirchhoff C, et al. Consistency of long-term outcome of acute Rockwood gradeⅢ acromioclavicular joint separations after K-wire transfixation[J]. J Trauma, 2009, 66(6): 1666-1671.
10. 　Flinkkilä T, Ristiniemi J, Hyvönen P, et al. Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation[J]. Acta Orthop Scand, 2002, 73(1): 50-53.
11. 　李珠, 梅炯, 吳衛平, 等．不穩定性鎖骨外側端骨折及肩鎖關節脫位的手術治療[J].骨與關節損傷雜志, 2004, 19(6): 367-368.
12. 　李欣, 何愛詠.鎖骨鉤鋼板與克氏針張力帶治療肩鎖關節脫位和鎖骨遠端骨折療效比較[J].中國矯形外科雜志, 2006, 14(24): 1855-1857, I0002.
13. 　Lyons FA, Rockwood CA Jr. Migration of pins used in operations on the shoulder[J]. J Bone Joint Surg(Am), 1990, 72(8): 1262-1267.
14. 　Lemos MJ, Tolo ET. Complications of the treatment of the acromioclavicular and sternoclavicular joint injuries， including instability[J]. Clin Sports Med, 2003, 22(2): 371-385.

《華西醫學》

克氏針張力帶與鎖骨鉤鋼板治療RockwoodⅢ型肩鎖關節脫位的療效比較

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《華西醫學》

克氏針張力帶與鎖骨鉤鋼板治療RockwoodⅢ型肩鎖關節脫位的療效比較

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