摘要
背景:目前肩锁关节脱位手术尚无统一标准,锁骨钩板固定是临床上较为常用的一种固定方式,但是微创的韧带重建技术与关节镜手术已经成为研究的热点。目的:观察关节镜下带线锚钉缝线桥缝合固定治疗肩锁关节脱位的应用价值。方法:选择2016年1月至2018年4月冀中能源邢台矿业集团总医院骨外科收治的TossyⅢ型肩锁关节脱位患者,随机分为2组。关节镜组患者采取关节镜下带线锚钉结合缝线桥技术进行复位固定治疗,锁骨钩钢板组患者采用锁骨钩钢板内固定。记录两组患者手术切口长度、手术花费时间、住院时间及恢复工作时间;术后3,6,12个月按照Lazzcano疗效标准对肩关节功能进行评价,并比较两组患者肩部疼痛目测类比评分、外展上举和前屈上举活动度的差异。所有患者均随访1年,记录两组患者并发症发生情况。研究已获得冀中能源邢台矿业集团有限责任公司总医院医学伦理委员会审核批准,且所有研究对象术前均签署知情同意书。结果与结论:①两组患者手术时间比较差异无显著性意义(P>0.05);关节镜组患者手术切口、住院时间、恢复工作时间均显著优于锁骨钩钢板组(P<0.01);②经Lazzcano疗效标准判定,术后3个月关节镜组患者优良率为84%,优于锁骨钩钢板组的66%(P<0.05);术后6,12个月关节镜组的优良率均高于锁骨钩钢板组,但差异无显著性意义(P>0.05);③两组患者术后3,6,12个月目测类比评分呈逐渐下降趋势(P<0.01),同一时间节点关节镜组患者目测类比评分显著低于锁骨钩钢板组(P<0.01);④两组患者术后3,6,12个月外展上举、前屈上举角度呈逐渐上升趋势(P<0.01),同一时间节点关节镜组患者外展上举、前屈上举角度均大于锁骨钩钢板组(P<0.01);⑤术后1年随访结果显示,关节镜组患者并发症发生率为6%,显著低于锁骨钩钢板组的63%(P<0.01);⑥与锁骨钩钢板固定相比,关节镜下带线锚钉缝线桥缝合固定治疗肩锁关节脱位具有创伤小、恢复快、并发症少、无需再次手术去除内植物等优势,手术同时还可以明确诊断关节内伴随的病变,并在必要时进行治疗,提高修复效果。
BACKGROUND:There is no uniform standard for acromioclavicular dislocation.Clavicular hook plate fixation is a commonly used fixation method clinically,but minimally invasive ligament reconstruction technology and arthroscopic surgery have become a research hotspot.OBJECTIVE:To observe the application value of suture bridge with thread anchor under arthroscopy in the treatment of acromioclavicular dislocation.METHODS:Patients with Tossy type III acromioclavicular dislocation who were admitted to Department of Orthopedic Surgery of General Hospital of Jizhong Energy Xingtai Mining Group between January 2016 and April 2018 were selected as the subjects.The patients were randomly divided into two groups.The patients in the arthroscopy group were treated with arthroscopic suture bridge technique with suture anchor for reduction and fixation,while those in the clavicle hook plate group were treated with clavicular hook plate for internal fixation.The length of surgical incision,duration of surgery,hospitalization time and time to return to work of both groups were recorded.The shoulder function was evaluated according to the Lazzcano criterion of curative effect at 3,6 and 12 months after surgery.The visual analogue scale score of shoulder pain,abduction and raising,forward bend and raising were compared between the two groups.All patients were followed up for 1 year to record the occurrence of complications.This study was approved by the Medical Ethics Committee of General Hospital of Jizhong Energy Xingtai Mining Group.All subjects signed the informed consent.RESULTS AND CONCLUSION:(1)There was no significant difference in the duration of surgery between the two groups(P>0.05).The surgical incision,hospitalization time and time to return to work of the arthroscopy group were significantly better than those of the clavicle hook plate group(P<0.01).(2)According to the Lazzcano criterion of curative effect,the excellent and good rate of curative effect in the arthroscopy group(84%)was significantly better than that in the clavicle hook plate group(66%)at 3 months after surgery(P<0.05).The excellent and good rates of curative effect in the arthroscopy group at 6 and 12 months after surgery were higher than those in the clavicle hook plate group(P>0.05).(3)Visual analogue scale scores of the two groups showed a decreasing trend at 3,6 and 12 months after surgery(P<0.01).The visual analogue scale score of arthroscopy group was significantly lower than that of the clavicle hook plate group at the same time point(P<0.01).(4)Angles of abduction and raising,forward bend and raising of both groups showed an increasing trend at 3,6 and 12 months after surgery(P<0.01).The angles of abduction and raising,forward bend and raising of the arthroscopy group were larger than those of the clavicle hook plate group at the same time point(P<0.01).(5)The 1-year follow-up results showed that the incidence of complications in the arthroscopy group(6%)was significantly lower than that in the clavicle hook plate group(63%)(P<0.01).(6)Compared with clavicular hook plate fixation,the technique of suture anchors under arthroscopy has the advantages of small trauma,quick recovery,fewer complications and no need to remove endografts again.Meanwhile,the surgery can also clearly diagnose the concomitant lesions in the joints and treat them when necessary,so as to improve the treatment effect.
作者
张尚普
鞠晓东
宋恒义
董智
王晨
孙国栋
Zhang Shangpu;Ju Xiaodong;Song Hengyi;Dong Zhi;Wang Chen;Sun Guodong(Department of Orthopedics,General Hospital of Jizhong Energy Xingtai Mining Group,Xingtai 054000,Hebei Province,China;Institute of Sports Medicine,Peking University Third Hospital,Beijing 100191,China)
出处
《中国组织工程研究》
CAS
北大核心
2021年第9期1417-1422,共6页
Chinese Journal of Tissue Engineering Research
基金
河北省医学科学研究课题重点科技研究计划(20191644),项目负责人:张尚普。
关键词
骨
肩锁关节脱位
关节镜
带线锚钉
缝线桥
TossyⅢ型
钩钢板
内固定
喙锁韧带
bone
acromioclavicular joint dislocation
arthroscopy
suture anchor
suture bridge
Tossy typeⅢ
hook plate
internal fixation
coracoclavicular ligament
作者简介
第一作者:张尚普,男,1972年生,河北省威县人,汉族,2009年石河子大学医学院毕业,硕士,副主任医师,主要从事关节与运动损伤方面的研究,https://orcid.org/0000-0001-8329-1904;通讯作者:鞠晓东,博士,副主任医师,北京大学第三医院运动医学研究所,北京市100191。
