創(chuàng)傷骨科

目的 探討采用喙鎖韌帶重建聯(lián)合鉤鋼板固定或縫合錨固定治療肩鎖關(guān)節(jié)脫位的療效。方法 自2007年2月至2010年4月，將Rockwood Ⅲ型以上肩鎖關(guān)節(jié)脫位并符合納入排除標(biāo)準(zhǔn)的患者隨機(jī)分為鉤鋼板固定組和縫合錨固定組，分別應(yīng)用雙股掌長(zhǎng)肌腱重建喙鎖韌帶聯(lián)合鉤鋼板或縫合錨固定治療。定期隨訪患者，在X線片上測(cè)量肩鎖間距和喙鎖間距，末次隨訪應(yīng)用Karlsson評(píng)分和Constant-Murley評(píng)分評(píng)估手術(shù)療效。應(yīng)用SPSS 13.0統(tǒng)計(jì)學(xué)軟件[MSOffice1]分析數(shù)據(jù)，等級(jí)資料應(yīng)用χ2檢驗(yàn)、計(jì)量資料應(yīng)用兩樣本t檢驗(yàn)分析，設(shè)定P＜0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果 16例患者失訪，89例患者獲得隨訪，隨訪時(shí)間24～42個(gè)月，平均30個(gè)月。[MSOffice2]其中鉤鋼板固定組46例，縫合錨固定組43例，兩組患者在年齡、性別、損傷側(cè)別、受傷至手術(shù)時(shí)間和Rockwood分型方面具有可比性。X線片上肩鎖間距和喙鎖間距：術(shù)后6個(gè)月內(nèi)兩組均無(wú)統(tǒng)計(jì)學(xué)差異（P>0.05）；術(shù)后24個(gè)月鉤鋼板固定組肩鎖間距和喙鎖間距均明顯大于縫合錨固定組（F=1.904，P=0.038；F=1.854，P=0.046）；鉤鋼板固定組術(shù)后24個(gè)月兩間距均大于其6個(gè)月測(cè)量數(shù)據(jù)[MSOffice3]（F=1.863，P=0.041；F=1.842，P=0.043）。末次隨訪Constant-Murley評(píng)分鉤鋼板固定組平均88.5分,縫合錨固定組平均92.7分，鉤鋼板固定組明顯低于縫合錨固定組（F=0.475，P=0.017）。Karlsson評(píng)分縫合錨固定組患者功能優(yōu)良率為95.4%，明顯優(yōu)于鉤鋼板固定組的80.5%（X2=4.564，P=0.033）。結(jié)論 喙鎖韌帶重建結(jié)合縫合錨固定治療肩鎖關(guān)節(jié)脫位患者療效優(yōu)于喙鎖韌帶重建結(jié)合鉤鋼板固定。鉤鋼板固定取出后，肩鎖間距和喙鎖間距顯著增加，可能與其療效較差有關(guān)。【關(guān)鍵詞】肩鎖關(guān)節(jié)；脫位；韌帶；內(nèi)固定器Comparative study on the treatment of acromioclavicular joint dislocation: coracoclavicular ligament reconstruction combined with hook plate fixation or suture-anchor fixationAN Wei-jun, SUN Jian-bin, YE Peng, GUO Wei-wei. Department of traumatic orthopedics, The General Hospital of Ningxia Medical University, Yinchuan 75004,ChinaCorresponding author: AN Wei-jun, Email: anweijun939@163.com【Abstract】 [MSOffice4]Objective To investigate the clinical outcomes of acromioclavicular joint (ACJ) dislocation treated with coracoclavicular ligament (CCL) reconstruction and hook plate fixation/suture-anchor fixation. Methods Patients with Rockwood type III or severer ACJ dislocations were randomly divided into two groups February 2007 to April 2010. They were treated with CCL reconstruction using double bundle of Palmaris longus, and subsequently fixed with hook plates or suture-anchors. Patients were followed up, and the AC distance and CC distance were measured on the postoperative X-ray films, and the outcomes were assessed according to Karlsson criteria and Constant-Murley shoulder score. SPSS 13.0 was employed to analyze the data. Ranked data was analyzed with the use ofχ2 test and measurement data with two sample t test. P less than 0.05 was considered as statistical significant difference. Result 89 patients were followed up for at least 24 months. There were 46 cases in hook plate fixation group and 43 cases in such-anchor fixation group, without significant difference in age, sex, injured side and Rockwood classification between both groups. Between both groups, no statistical difference was detected in the AC and CC distance measured within six months after operation (P>0.05). The AC and CC distances of hook plate fixation group measured in 24 months postoperatively were larger than those in such-anchor fixation group, respectively (F=1.904,P=0.038;F=1.854,P=0.046). In hook plate fixation group, the AC and CC distances measured in 24 months postoperatively were larger than those measured in 6 month postoperatively, respectively(F=1.863,P=0.041; F=1.842,P=0.043). According to Constant-Murley shoulder score, the average score was 88.5 for hook plate fixation group and 92.7 for such-anchor fixation group(F=0.475,P=0.017). According to Karlsson Criteria, the excellent and good rate of the functional recovery was 95.4% in such-anchor fixation group, better than hook plate fixation group (X2=4.564,P=0.033). Conclusion The clinical outcomes of ACJ dislocation treated with CCL reconstruction and suture-anchor fixation are better than those treated with CCL reconstruction and hook plate fixation. The AC and CC distances increase after the removal of hook plate, which may be associated with poor functional recovery.【Key Words】 Acromioclavicular joint; Dislocations; Ligaments; Internal fixators

[摘要] 目的 探討鎖骨遠(yuǎn)端切除對(duì)鎖骨功能的影響。方法 自2005年-2010年，我們采用鎖骨遠(yuǎn)端切除術(shù)對(duì)鎖骨遠(yuǎn)端骨折、肩鎖關(guān)節(jié)骨折或骨折脫位及肩鎖關(guān)節(jié)炎共37例進(jìn)行了手術(shù)治療。其中鎖骨遠(yuǎn)端粉碎性骨折9例，肩鎖關(guān)節(jié)骨折脫位23例，肩鎖關(guān)節(jié)炎5例。對(duì)以上不同病例采用不同的手術(shù)方法進(jìn)行治療，其中皆包含鎖骨遠(yuǎn)端切除。結(jié)果37例皆獲得了隨訪，隨訪時(shí)間平均為1年?；颊叩念^頸部活動(dòng)及肩關(guān)節(jié)活動(dòng)基本或達(dá)到正常，和健側(cè)肩關(guān)節(jié)功能對(duì)比，沒(méi)有顯著性差異。結(jié)論 頭頸部和肩關(guān)節(jié)活動(dòng)取決于鎖骨的位置和穩(wěn)定性，鎖骨遠(yuǎn)端切除對(duì)鎖骨的功能沒(méi)有影響。 [關(guān)鍵詞] 鎖骨遠(yuǎn)端切除術(shù)Is distal clavicle resection influence on the clavicle functions AN Wei-jun,FENG-yu,WANG-zheng.(Affiliated Hosp. of Ningxia Med. University.,Yinchuan 750004,China ) [Abstract] Objective To study that the distal clavicle resection influence on the clavicle function. Method From 2005 to 2010, we used distal clavicle resection to surgical treating 37 cases of the distal clavicle fracture, fracture and dislocation of acromioclavicular and acromioclavicular arthritis. 9 cases in which distal clavicle conminuted fracture, acromioclavicular joint fracture-dislocation in 23 cases, 5 cases of acromioclavicular arthritis. Different cases of the above methods using different surgical treatment,All cases are included distal clavicle resection. Results 37 patients were obtained followed up of an average of 1 year. Activity in patients with head and neck and shoulder joint activities to achieve the basic or normal, and the contralateral shoulder function compared, no significant difference. Conclusion The head and neck and shoulder range of motion depends on the location and stability of the clavicle, distal clavicle resection did not affect the function of the clavicle.[Key words ] distal clavicle resection

[摘要][目的]評(píng)價(jià)改良Weaver-Dunn技術(shù)治療肩鎖關(guān)節(jié)脫位的臨床療效并與傳統(tǒng)方法（包括肩鎖鉤鋼板固定和克氏針鋼絲張力帶固定）進(jìn)行比較，以確定其治療優(yōu)勢(shì)。[方法] 對(duì)Rockwood分型3型以上肩鎖關(guān)節(jié)脫位或骨折脫位，采用改良Weaver-Dunn技術(shù)手術(shù)治療30例，對(duì)照分析采用肩鎖鉤鋼板治療46例，采用克氏針鋼絲張力帶治療41例，分別對(duì)其手術(shù)時(shí)間、平均住院日、是否需要二次手術(shù)、手術(shù)費(fèi)用及術(shù)后肩關(guān)節(jié)功能進(jìn)行比較。117例病例均獲得了隨訪,平均隨訪時(shí)間36.5 個(gè)月。[結(jié)果]改良Weaver-Dunn技術(shù)治療組：一次手術(shù)即可完成、無(wú)術(shù)后復(fù)發(fā)或再脫位、平均住院日及手術(shù)費(fèi)用均低于傳統(tǒng)手術(shù)（傳統(tǒng)手術(shù)常需兩次手術(shù)），但手術(shù)時(shí)間長(zhǎng)于傳統(tǒng)手術(shù)，術(shù)后肩關(guān)節(jié)功能采用UCLA肩關(guān)節(jié)評(píng)分系統(tǒng)評(píng)價(jià)優(yōu)良率96.6%明顯高于對(duì)照組（P<0.05），改良Weaver-Dunn技術(shù)還可做為傳統(tǒng)手術(shù)失敗的補(bǔ)救手段。[結(jié)論]改良Weaver-Dunn技術(shù)治療肩鎖關(guān)節(jié)脫位或骨折脫位是一種理想的方法，與傳統(tǒng)手術(shù)方法相比具有明顯的優(yōu)勢(shì)，。[關(guān)鍵詞] 改良Weaver-Dunn技術(shù)， 肩鎖關(guān)節(jié)脫位Surgical treatment of acromioclavicular dislocation or fracture-dislocation by Modified Weaver-Dunn procedureThe Affiliated Hosp. of Ningxia Med.Coll.Orthopaedic Department An weijun[Abstract] [Objective] To evaluate the clinical effect of operation on the acromioclavicular dislocation or fracture-dislocation perfomed by modified Weaver-Dunn procedure,and compaired it with traditional operation by acromioclavicular hook plate and K-wire tension-band respectly so as to demonstrate its advantages. [Method] To surgical treat Rockwood type Ⅲ acromioclavicular dislocation or fracture-dislocation ,perfomed by modified Weaver-Dunn procedure 30 cases, fixed by acromioclavicular hook plate 46 cases, by K-wire tension-band 41cases.All of the 117cases were followed- up, The average time was 36.5 months. [Results] The modified Weaver-Dunn technique groups: accomplish operation only once time,no postoperation redislocation or recrudesce,the average stay-in hospital time and the cost was lower than the traditional tratement groups,but the operation time was longer.The postoperation shoulder function was evaluated by UCLA scoring system:the excellent and good aws 96.6% , higher than the other groups significantly (P <0.05). The modified Weaver-Dunn technique is also a kind of remedy method for the unsuccessful cases that was treated by the traditional methods. [Conclusion]The modified Weaver-Dunn techeque is a kind of ideal way to surgical treat acromioclavicular,have more advantages than the traditional methods.[Key words] Modified Weaver-Dunn technique; Acromioclavicular dislocation or fracture-dislocation