摘要
目的 探讨一种改良的小切口三钛板双束悬吊固定技术治疗急性肩锁关节脱位的早期疗效.方法 回顾性分析2021年6月至2023年8月江苏省苏北人民医院骨科采用改良三钛板双束悬吊固定技术治疗23例急性肩锁关节脱位患者的资料.男9例,女14例;年龄(52.2±10.6)岁.记录手术切口长度、手术时间、术中出血量及并发症发生情况.记录并比较术前与末次随访时患者的疼痛视觉模拟评分(VAS)、Constant评分、美国肩肘外科协会评分(AESE)、肩关节活动度(前屈、外展、体侧外旋).测量并比较术后第2天与末次随访时患者的喙锁间隙(CCD)、锁骨骨道宽度和喙突骨道宽度.结果 所有患者术后获12(12,16)个月随访.手术切口长度为5(4,5)cm,手术时间为50(40,60)min,术中出血量为30(20,30)mL.无切口感染、骨折、内固定失效等并发症发生.末次随访时患者疼痛VAS评分、Constant评分、AESE评分、肩关节前屈、肩关节外展、肩关节体侧外旋活动度分别为 0(0,0)分、(92.8±4.9)分、(90.4±5.7)分、175°(170°,180°)、175°(170°,175°)、85°(80°,85°),均较术前的 6(5,6)分、(40.4±7.2)分、(39.3±7.1)分、85°(80°,85°)、85°(80°,90°)、35°(35°,40°)显著改善,差异均有统计学意义(P＜0.05).患者术后第2天与末次随访时喙锁间隙分别为(6.1±1.3)、(7.5±1.7)mm,差异有统计学意义(P＜0.05).与术后第2天相比,末次随访时所有患者喙锁间隙增宽均＜4 mm,优良率为100％(23/23);内侧锁骨骨道、喙突骨道增宽均＜2 mm,优良率100％(23/23);有2例患者外侧锁骨骨道增宽＞2 mm,优良率为91％(21/23).结论 改良三钛板双束悬吊固定术是治疗急性肩锁关节脱位复位固定可靠、肩关节功能恢复良好.该技术手术时间短,手术操作难度小、安全性高、术后骨道增宽小.
Abstract
Objective To evaluate the early clinical outcomes of modified suspended fixation with triple plates and double beams through a limited incision in the treatment of acroxoclavicular dislocation.Methods A retrospective study was conducted to analyze the 23 patients with acromioclavicular dislocation who had been treated at Department of Orthopedics,The People's Hospital of Northern Jiangsu from June 2021 to August 2023 by modified suspended fixation with triple plates and double beams through a limited incision.There were 9 males and 14 females with an age of(52.2±10.6)years.The incision length,operation time,intraoperative bleeding and complications were recorded.The visual analogue scale(VAS)pain score,Constant-Murley shoulder score,American Shoulder and Elbow Surgeons(ASES)score,range of shoulder motion(anterior flexion,abduction,lateral rotation)were recorded and compared between preoperation and the last follow-up.The coracoclavicular distance(CCD),clavicle tract width and coracoid tract width were measured and compared between postoperative day 2 and the last follow-up.Results The patients were followed up for 12(12,16)months.The incision length was 5(4,5)cm,the operation time 50(40,60)min,and the intraoperative bleeding 30(20,30)mL.No such complications occurred as incision infection,fracture,or failure of internal fixation.The VAS pain score,Constant-Murley shoulder score,ASES score,anterior flexion,abduction and lateral rotation of the shoulder at the last follow-up were,respectively,0(0,0)point,(92.8±4.9)points,(90.4±5.7)points,175°(170°,180°),175°(170°,175°),and 85°(80°,85°),significantly improved compared with the preoperative values[6(5,6)points,(40.4±7.2)points,(39.3±7.1)points,85°(80°,85°),85°(80°,90°),and 35°(35°,40°)](P＜0.05).The CCD was(6.1±1.3)mm at postoperative day 2 and(7.5±1.7)mm at the last follow-up,showing a significant difference(P＜0.05).Compared with postoperative day 2,the CCD widening at the last follow-up was＜4mm in all patients,giving an excellent rate of 100％(23/23).The medial clavicle tract widening and the medial coracoid tract widening at the last fol-low-up were both＜2 mm in all patients,giving an excellent rate of 100％(23/23).The lateral clavicle tract widening at the last follow-up was＞2 mm in 2 patients,giving an excellent rate of 91％(21/23).Conclu-sions In the treatment of acroxoclavicular dislocation,our modified suspended fixation with triple plates and double beams through a limited incision can lead to reliable reduction fixation and good recovery of shoulder function,showing advantages of short surgical time,easy surgical operation,high safety,and minimal postop-erative widening of bone tracts.
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