目的:比较双袢与"Y"形三袢TightRope纽扣钢板内固定治疗新鲜RockwoodⅢ～Ⅴ型肩锁关节脱位的临床疗效及安全性。方法:回顾性分析2016 年1 月至2019 年5 月收治的74 例肩锁关节脱位患者的病例资料，其中采用双袢TightRope纽扣钢板内固定治疗者43 例(双袢组)，采用"Y"形三袢TightRope纽扣钢板内固定治疗者31 例(三袢组)。比较2 组患者的手术时间、喙锁间距差值、肩部疼痛视觉模拟量表(visual analogue scale，VAS)评分、加州大学洛杉矶分校(University of California Los Angeles，UCLA)肩关节量表评分、Constant-Murley肩关节评分及并发症发生率。结果:双袢组的手术时间短于三袢组[(31。37±4。03)min，(50。94±5。66)min，t=17。387，P=0。000)]。术后 6 周、24 周、1 年以及末次随访时，双袢组的喙锁间距差值均高于三袢组[(1。60±1。76)mm，(0。26±0。23)mm，t=4。220，P=0。000;(2。11±2。11)mm，(0。31±0。31)mm，t=4。695，P=0。000;(2。19±2。19)mm，(0。38±0。37)mm，t=4。536，P=0。000;(2。21±2。21)mm，(0。40±0。39)mm，t=4。499，P=0。000]。末次随访时，2 组患者的肩部疼痛VAS评分均较术前降低(t=32。538，P=0。000;t=24。849，P=0。000)，2 组患者的肩部疼痛VAS评分比较，差异无统计学意义[(0。56±0。70)分，(0。55±0。72)分，t=0。058，P=0。954]。末次随访时，2 组患者的UCLA肩关节量表评分均较术前增高(t=-108。72，P=0。000;t=-52。267，P=0。000)，双袢组的 UCLA肩关节量表评分低于三袢组[(47。02±1。71)分，(49。32±2。77)分，t=-2。490，P=0。015]。末次随访时，2 组患者的Constant-Murley肩关节评分均较术前增高(t=-63。617，P=0。000;t=-67。607，P=0。000)，双袢组的 Constant-Murley肩关节评分低于三袢组[(94。58±2。70)分，(94。61±3。12)分，t=-2。135，P=0。036]。双袢组2 例发生锁骨骨溶解，三袢组1 例发生切口感染。2 组患者并发症发生率比较，差异无统计学意义(P=1。000)。结论:双袢与"Y"形三袢TightRope纽扣钢板内固定治疗新鲜RockwoodⅢ～Ⅴ型肩锁关节脱位，均能减轻肩关节疼痛，但双袢固定的手术时间更短、"Y"形三袢固定的肩关节功能恢复得更好。
A comparative study of double-loop versus Y-shaped triple-loop TightRope button plate internal fixation for treatment of Rockwood typeⅢ-Ⅴ fresh acromioclavicular joint dislocation
Objective:To compare the clinical outcomes and safety of double-loop versus Y-shaped triple-loop TightRope button plate internal fixation in treatment of Rockwood typeⅢ-Ⅴfresh acromioclavicular joint dislocation(ACJD).Methods:The medical records of 74 ACJD patients recruited from January 2016 to May 2019 were retrospectively analyzed.Forty-three patients were treated with double-loop TightRope button plate internal fixation(double-loop group),and 31 ones with Y-shaped triple-loop TightRope button plate internal fixation(triple-loop group).The operative time,coracoclavicular distance(CCD)difference,shoulder pain visual analogue scale(VAS)score,Uni-versity of California Los Angeles(UCLA)shoulder score,Constant-Murley shoulder score,and postoperative complications were compared between the 2 groups.Results:The operative time was shorter in double-loop group compared to triple-loop group(31.37±4.03 vs 50.94±5.66 minutes,t=17.387,P=0.000).The difference of CCD was larger in double-loop group compared to triple-loop group at postoperative week 6,week 24,month 12 and the last follow-up(1.60±1.76 vs 0.26±0.23 mm,t=4.220,P=0.000;2.11±2.11 vs 0.31±0.31 mm,t=4.695,P=0.000;2.19±2.19 vs 0.38±0.37 mm,t=4.536,P=0.000;2.21±2.21 vs 0.40±0.39 mm,t=4.499,P=0.000).The shoulder pain VAS score decreased in the 2 groups at the last follow-up compared to pre-operation(t=32.538,P=0.000;t=24.849,P=0.000),and the difference was not statistically significant between the 2 groups(0.56±0.70 vs 0.55±0.72 points,t=0.058,P=0.954).The UCLA shoulder score increased in the 2 groups at the last follow-up compared to pre-operation(t=-108.72,P=0.000;t=-52.267,P=0.000),and it was lower in double-loop group compared to triple-loop group(47.02±1.71 vs 49.32±2.77 points,t=-2.490,P=0.015).The Constant-Murley shoulder score increased in the 2 groups at the last follow-up com-pared to pre-operation(t=-63.617,P=0.000;t=-67.607,P=0.000),and it was lower in double-loop group compared to triple-loop group(94.58±2.70 vs 94.61±3.12 points,t=-2.135,P=0.036).Two patients suffered from clavicular osteolysis in double-loop group,and 1 patient experienced incision infection in triple-loop group.There was no statistical difference in complication incidences be-tween the2 groups(P=1.000).Conclusion:Both double-loop and Y-shaped triple-loop TightRope button plate internal fixation can allevi-ate the shoulder pain in treatment of Rockwood typeⅢ-Ⅴfresh ACJD.However,the former requires shorter operative time,while the latter achieves better outcome in shoulder function recovery.
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