Long-term Clinical and Radiological Outcomes of Kirschner Tension Band Fixation versus Clavicular Hook Plate for RockwoodⅢ Acromioclavicular Joint Dislocation_West China Medical Journal

Authors：

YANG Heng , WANG Jun , ZHANG Dingwei , WANG Tao , SHI Bo , KANG Bing , LIU Du

Department of Orthopedics, Mianyang Central Hospital, Mianyang, Shichuan 621000, P. R. China;

Corresponding author：

Keywords：

肩锁关节脱位; 克氏针张力带; 锁骨钩钢板

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目的　比较克氏针张力带与锁骨钩钢板治疗RockwoodⅢ型肩锁关节脱位的临床疗效。方法　1999年1月－2007年3月，收治肩锁关节脱位患者29例，分别采用克氏针张力带联合喙锁韧带重建（克氏针组10例）和锁骨钩钢板（钢板组19例）治疗。其中男18例，女11例；年龄19～50岁，平均38.2岁。患者均为新鲜RockwoodⅢ型肩锁关节脱位，受伤至手术时间1～16 d，平均3 d。两组患者性别、年龄、受伤至手术时间等一般资料比较差异无统计学意义（P＞0.05）。进行两组患者术后临床及影像学评估比较。结果　25例患者（克氏针组10例，钢板组15例）获随访，随访时间2～12年，平均6年。术后克氏针组发生克氏针弯曲5例、断裂1例；钢板组切口浅表感染2例，经换药后治愈，其余患者切口Ⅰ期愈合。两组患者肩锁关节均获得良好功能，组间比较差异无统计学意义（P＞0.05）。影像学方面：与克氏针组相比，在患肢负重位时钢板组喙锁间隙间距增加了23%（P＜0.05），非负重位两组间距差异无统计学意义（P＞0.05）。术后8～12周出现喙锁韧带钙化，钢板组12例、克氏针组2例（P＜0.05）。术后6个月出现肩锁关节骨性关节炎，钢板组2例、克氏针组1例（P＞0.05）。肩关节功能与影像学结果无相关性（r=0.096，P＞0.05）。结论　克氏针张力带联合喙锁韧带重建和锁骨钩钢板固定治疗RockwoodⅢ型肩锁关节脱位均可获得良好的临床功能。与克氏针张力带相比，锁骨钩钢板固定具有手术操作简便、疗效确切、并发症少、能够早期康复锻炼等优点。

Citation： YANG Heng,WANG Jun,ZHANG Dingwei,WANG Tao,SHI Bo,KANG Bing,LIU Du. Long-term Clinical and Radiological Outcomes of Kirschner Tension Band Fixation versus Clavicular Hook Plate for RockwoodⅢ Acromioclavicular Joint Dislocation. West China Medical Journal, 2012, 27(10): 1446-1449. doi: Copy

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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, 吴卫平, 等．不稳定性锁骨外侧端骨折及肩锁关节脱位的手术治疗[J].骨与关节损伤杂志, 2004, 19(6): 367-368.
12.	李欣, 何爱咏.锁骨钩钢板与克氏针张力带治疗肩锁关节脱位和锁骨远端骨折疗效比较[J].中国矫形外科杂志, 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, 吴卫平, 等．不稳定性锁骨外侧端骨折及肩锁关节脱位的手术治疗[J].骨与关节损伤杂志, 2004, 19(6): 367-368.
12. 　李欣, 何爱咏.锁骨钩钢板与克氏针张力带治疗肩锁关节脱位和锁骨远端骨折疗效比较[J].中国矫形外科杂志, 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.

West China Medical Journal

Long-term Clinical and Radiological Outcomes of Kirschner Tension Band Fixation versus Clavicular Hook Plate for RockwoodⅢ Acromioclavicular Joint Dislocation

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