经皮植入与传统切口植入锁骨钩板治疗急性肩锁关节脱位疗效对比

发布时间：2018-03-19 00:25

本文选题：肩锁关节脱位　切入点：锁骨钩板　出处：《新乡医学院》2017年硕士论文　论文类型：学位论文

【摘要】：背景肩锁关节脱位是骨科各种创伤疾病中较为常见的疾病类型之一,其临床发病率呈现出逐年升高的趋势,故对于肩锁关节脱位的相关临床研究具有重要的现实意义和研究价值。目前重度肩锁关节脱位(Rockwood III型及以上),常规保守治疗效果不佳,首选的治疗方法以手术治疗为主。近年来,应用锁骨钩板治疗急性肩锁关节脱位逐渐成为一种成熟、标准的治疗方案,主要包括传统切口植入锁骨钩板和经皮植入锁骨钩板。但是传统手术切口放置锁骨钩板的创伤较大,术后恢复周期较长,为优化手术操作,加快术后康复,本研究总结临床实践经验,采用两种手术方法治疗急性肩锁关节脱位并进行比较分析。目的通过经皮植入锁骨钩板与传统切口植入锁骨钩板治疗急性肩锁关节脱位的临床疗效差异比较,优化锁骨钩板治疗急性肩锁关节脱位的手术操作,以期达成急性肩锁关节脱位患者的术后快速康复。为急性肩锁关节脱位患者提供疗效更佳的治疗方法,同时也为急性肩锁关节脱位临床研究提供可靠依据。方法选取我院2013年12月至2015年12月期间收治的急性肩锁关节脱位患者124例为本次研究的调查对象,按照患者给予手术治疗方法的不同将患者分成了研究组(68例)和对照组(56例)。研究组68例患者给予经皮植入锁骨钩板的方式进行治疗,对照组56例患者给予传统切口植入锁骨钩板的方式进行治疗。观察和比较两组患者实施不同手术方式治疗后的手术切口长度(cm)、手术时间(min)、术中出血量(ml)以及临床综合疗效。结果(1)比较两组患者实施不同手术治疗方法后的切口长度、手术时间和术中出血量三项指标。研究组患者的切口长度为(3.48±0.33)cm,对照组患者的切口长度为(7.41±0.86)cm;研究组患者的手术时间为(50.34±7.43)min,对照组患者的手术时间为(57.86±10.34)min;研究组患者的术中出血量为(60.34±9.23)ml,对照组患者术中出血量为(69.36±9.46)ml,两组进行比较,差异均具有明显的统计学意义(P均0.05);(2)研究组患者实施手术治疗后的临床整体优良率为94.12%;对照组患者实施手术治疗后的临床整体优良率为82.14%。两组患者实施不同手术治疗后的临床整体优良率组间比较,研究组患者的临床整体优良率水平显著高于对照组患者。组间数据比较差异具有显著统计学意义(χ2=4.3968,P=0.0360)。结论与传统手术切口植入锁骨钩钢板相比,经皮植入锁骨钩板治疗急性肩锁关节脱位具有良好的临床疗效,手术操作简便、手术时间短、手术出血量少、术后切口美观度高、并发症少,具有良好的临床应用价值和推广价值。
[Abstract]:Background dislocation of acromioclavicular joint is one of the most common types of trauma diseases in orthopedic department, and its clinical incidence is increasing year by year. Therefore, it has important practical significance and research value for the clinical study of acromioclavicular joint dislocation. At present, Rockwood III type and above type of severe acromioclavicular dislocation, routine conservative treatment is not good. In recent years, the treatment of acute acromioclavicular dislocation with clavicular hook plate has gradually become a mature and standard treatment. The traditional incision was mainly used to implant clavicle hook plate and percutaneous clavicle hook plate, but the wound of clavicular hook plate placement in traditional surgical incision was larger and the recovery period was longer. In order to optimize the operation and accelerate the postoperative recovery, This study summarizes the clinical experience, Two kinds of surgical methods were used to treat acute acromioclavicular dislocation. Objective to compare the clinical effects of percutaneous clavicular hook plate implantation and traditional incision clavicular hook plate implantation in the treatment of acute acromioclavicular dislocation. To optimize the operative procedures of clavicular hook plate for the treatment of acute acromioclavicular dislocation, in order to achieve a rapid recovery after operation, and to provide a better therapeutic method for the patients with acute acromioclavicular dislocation. Methods 124 patients with acute acromioclavicular dislocation admitted from December 2013 to December 2015 were selected as the subjects of this study. The patients were divided into study group (n = 68) and control group (n = 56) according to the different methods of surgical treatment. In study group, 68 patients were treated by percutaneous implantation of clavicle hook plate. 56 patients in the control group were treated with traditional incision implantation of clavicle hook plate. The length of incision, the time of operation and the volume of blood loss during operation were observed and compared between the two groups. Results 1) the incision length of the two groups after different surgical treatment was compared. The length of incision was 3.48 卤0.33 cm in the study group, 7.41 卤0.86 cm in the control group, 50.34 卤7.43 min in the study group and 57.86 卤10.34 min in the control group. The volume of middle bleeding was 60.34 卤9.23 ml, while that of control group was 69.36 卤9.46 ml. The overall excellent and good rate was 94.12 in the study group and 82.14 in the control group. Comparison of the overall clinical excellent and good rates after treatment, The overall excellent and good rate of the patients in the study group was significantly higher than that in the control group. There was a significant difference between the two groups (蠂 2 4.3968 P < 0.03600.Conclusion compared with the traditional surgical incision, the clavicle hook plate was implanted into the clavicle hook plate. Percutaneous clavicular hook plate implantation in the treatment of acute acromioclavicular joint dislocation has a good clinical effect, the operation is simple, the operation time is short, the amount of operative bleeding is less, the postoperative incision aesthetic degree is high, the complication is less. It has good clinical application value and popularizing value.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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