摘要
目的 ：比较Endobutton钢板结合锚钉修复与锁骨钩钢板治疗肩锁关节脱位的临床疗效。方法：回顾性分析自2012年1月至2014年8月接受手术治疗的RockwoodⅢ型以上肩锁关节脱位患者83例。34例接受了Endobutton钢板结合锚钉修复治疗（Endobutton组）,其中男23例,女11例;平均年龄（39.0±6.3）岁（26～51岁）;受伤至手术时间平均（4.1±1.3）d（3～7 d）;左侧14例,右侧20例;摔伤28例,车祸伤6例。49例接受锁骨钩钢板治疗（钢钩板组）,其中男33例,女16例;平均年龄（37.9±6.3）岁（27～53岁）;受伤至手术时间平均（4.1±1.1）d（2～7 d）;左侧18例,右侧31例;摔伤36例,车祸伤13例。比较患者术中出血量、手术时间、切口大小、术后并发症及术后喙锁间隙、肩关节功能、生活质量评分。结果：钩钢板组49例中43例行二次手术拆除钢板,32例出现肩关节活动时疼痛或活动范围受限;Endobutton组34例术后均未出现肩关节活动时疼痛及活动范围受限。两组患者随访期间均未出现患侧肩锁关节再次脱位。两组患者手术时间、术中出血量比较差异无统计学意义（P〉0.05）,钩钢板组切口长于Endobutton组（P〈0.05）;两组患者术后16个月时健侧和患侧喙锁间隙无明显差异,且钩钢板组和Endobutton组患侧比较喙锁间隙也无明显差异（P〉0.05）。术后2个月两组患侧Constant、SF-36评分差异均无统计学意义（P〉0.05）;术后16个月两组Constant评分均高于术后2个月（P〈0.05）,且钩钢板组患侧Constant评分低于Endobutton组（P〈0.05）,钩钢板组健侧Constant评分高于患侧（P〈0.05）,Endobutton组健侧与患侧Constant评分差异无统计学意义（P〉0.05）。术后16个月两组SF-36评分均高于术后2个月,且钩钢板组SF-36评分低于Endobutton组（P〈0.05）。结论：Endobutton钢板结合锚钉修复能够有效固定RockwoodⅢ型以上急性肩锁关节脱位,并发症少,避免了二次手术拆除。
Objective：To compare the clinical effect of Endobutton plates combined with an anchor and clavicle hook plate in the treatment of acromioclavicular dislocation.Methods：From January 2012 to August 2014,83 patients with Rockwood type Ⅲ acromioclavicular dislocation underwent surgical treatments.Among them,34 patients were treated with Endobutton plate and anchor repair（Endobutton group）,including 23 males and 11 females,and the mean age was（39.0±6.3）years old（26 to 51 years old）;the average time from injury to operation was（4.1±1.3） days（3 to 7 days）;the injured side;14left,20 right;the dislocation in 28 patients dues to fall,6 patients dues traffic accident.There were 49 patients treated with clavicular hook plate（hook plate group）,including 33 males and 16 females;the mean age was（37.9±6.3） years old（27 to 53 years old）;the average time from injury to operation was（4.1 ±1.1） days（2 to 7 days）;the injured side;18 left,31 right;the dislication in 36 patients dues to fall,13 patients dues traffic accidents.The indexes such as intraoperative bleeding volume,operation time,incision size,postoperative complication and postoperative coracoclavicular space,shoulder joint function,and life quality were compared between two groups.Results：In the hook plate group with 49 patients,the plates in 43 patients were removed at the secondary operation,and 32 patients had shoulder pain or limited active range.Thirty-four patients in the Endobutton group had no pain symptoms and limited active range.All the patients did not suffer acromioclavicular dislocation again.There was no significant difference between the two groups in operation time,and intraoperative bleeding volume（P〉0.05）.The incision length in the hook plate group was longer than that in Endobutton group（P〈0.05）.The coracoclavicular space of the uninjured and injured side in two groups respectively had no significant differences,and the coracoclavicular space in the injured side between two group had no significant difference（P〉0.05）.There were no significant differences of Constant score and SF-36 between two groups 2 months after operation（P〉0.05）.Sixteen months after operation,the Constant score in the injured side of both groups was higher than that in 2 months postoperative.But the Constant score in the injured side of hook plate group was higher than that in Endobutton group（P〈0.05）.The Constant score in the uninjured side had no significant differences between two group（P〉0.05）.In hook plate group,the Constant score in the uninjured side was higher than that in the injured side.In Endobutton group,there were no significant differences of Constant score between two sides.The 16-month postoperative SF-36 in the injured side of both groups was higher than the 2-month postoperative one,but 16-month postoperative SF-36 in hook plate group was lower than that in Endobutton group（P〈0.05）.Conclusion：Endobutton plate combined with an anchor can effectively fix Rockwood type Ⅲ or more acute acromioclavicular dislocation.The method has less complications,avoiding secondary removal of internal fixation.
作者
胡劲涛
陆建伟
傅利锋
HU Jin-tao LU Jian-wei FU Li-feng(Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China)
出处
《中国骨伤》
CAS
2016年第9期841-846,共6页
China Journal of Orthopaedics and Traumatology
