Objective: To compare the effectiveness of coracoclavicular ligament reconstruction between by using autologous plantaris tendon graft combined with hook plate fixation and allogeneic tendon graft combined with hook plate fixation for treating acromiocavicular joint dislocation.
Methods: Thirty-three patients with acromioclavicular joint dislocation who accorded with the inclusion criteria between January 2013 and June 2014 were assigned into 2 groups. The patients were treated with autologous plantaris tendon graft combined with hook plate fixation in group A (n=17), and with allogeneic tendon graft combined with hook plate fixation in group B (n=16). Thirteen-one patients was followed up more than 12 months (15 in group A and 16 in group B). There was no significant difference in gender, age, cause of injury, sides, time between injury and surgery, and type of dislocation (P>0.05). The assessments included operation time, hospitalization time, hospitalization expenses, shoulder range of motion, gap of acromioclavicular, Constant-Murley scores, and visual analogue scale (VAS) for pain.
Results: The operation time of group A was significantly longer than that of group B, and the hospitalization expense was significantly lower than that of group B (P<0.05). There was no significant difference in hospitalization time (t=1.046, P=0.316). The incisions healed by first intention, and hook plate was removed after 3 months. The mean follow-up time was 21.3 months (range, 19-34 months) in group A and was 23.7 months (range, 18-37 months) in group B. X-ray examination showed no osteolysis. There was no significant difference in gap of acromiocavicular between 2 groups at preoperation, 1 week after operation, and last follow-up (P>0.05). No redislocation of acromioclavicular joint and rejection reaction occurred during follow-up. At last follow-up, there was no significant difference in shoulder range of motion, Constant-Murley score, and VAS score between 2 groups (P>0.05).
Conclusions: Coracoclavicular ligament reconstruction by autologous plantaris tendon or allogeneic tendon graft combined with hook plate fixation for the treatment of acromioclavicular joint dislocation can achieve good effectiveness. The appropriate treatment should be chosen according to the patient's economic situation.
目的: 比较自体跖肌腱及同种异体肌腱重建喙锁韧带联合钩钢板固定治疗肩锁关节脱位的疗效差异。.
方法: 将2013年1月-2014年6月收治并符合选择标准的33例肩锁关节脱位患者随机分为两组，分别为自体跖肌腱重建喙锁韧带结合钩钢板固定组（A组，17例）以及同种异体肌腱重建喙锁韧带结合钩钢板固定（B组，16例）。术后31例患者随访达12个月，其中A组15例、B组16例。两组患者性别、年龄、侧别、致伤原因、伤后至手术时间、肩锁关节脱位分型等一般资料比较，差异均无统计学意义（P＞0.05），具有可比性。记录并比较两组手术时间、住院时间及住院费用；采用X线片测量术前、术后1周及末次随访时患肩喙锁间隙；末次随访时测量肩关节活动度并采用Constant-Murley评分评价关节功能恢复情况，采用疼痛视觉模拟评分（VAS）评估患肩疼痛情况。.
结果: 与B组比较，A组手术时间明显延长，住院费用明显降低，比较差异有统计学意义（P＜0.05）；两组住院时间比较差异无统计学意义（t=1.046，P=0.316）。两组患者切口均Ⅰ期愈合，钩钢板均于术后3个月取出。两组患者均获随访，其中A组随访时间19～34个月，平均21.3个月；B组18～37个月，平均23.7个月。X线片复查示无肩峰下骨溶解等情况发生，两组术前、术后1周及末次随访时的患肩喙锁间隙比较，差异均无统计学意义（P＞0.05）。随访期间，无肩锁关节再脱位、排斥反应发生。末次随访时，两组肩关节活动度、Constant-Murley评分及VAS评分比较，差异均无统计学意义（P＞0.05）。.
结论: 应用自体跖肌腱或同种异体肌腱重建喙锁韧带联合钩钢板治疗肩锁关节脱位，临床疗效满意；但自体跖肌腱重建手术费用低于同种异体肌腱，因此可根据患者经济情况选择合适治疗方式。.
Keywords: Acromioclavicular joint dislocation; Allogeneic tendon; Autologous tendon; Coracoclavicular ligament; Hook plate.