锁骨钩钢板与双Endobutton钢板治疗肩锁关节脱位的对比研究

Comparative study of double Endobutton and clavicular hook plate for the treatment of acromioclavicular joint dislocation

目的比较双Endobutton钢板与AO锁骨钩钢板治疗Rockwood Ⅲ～Ⅴ型肩锁关节脱位的疗效。方法2008年2月至2008年12月，收治38例Rockwood Ⅲ～Ⅴ型肩锁关节脱位患者。其中18例应用双Endobutton钢板治疗，男12例，女6例；年龄（38．5±6．2）岁；左侧10例，右侧8例；RockwoodⅢ型13例，Ⅳ型2例，V型3例。20例应用AO锁骨钩钢板治疗，男14例，女6例；年龄（34．8±5．9）岁；左侧11例，右侧9例；Rockwoodm型13例，Ⅳ型3例，V型4例。术前两组患者一般资料具有可比性。分别对两组患者术中及住院期间的各项指标、术后的影像学结果、临床疗效结果及并发症进行对比分析。结果锁骨钩钢板组的手术时间相对较短、术中平均失血量较少，而切口长度相对较长。术后双Endobutton钢板组的肩部疼痛发生率低于锁骨钩钢板组，肩关节外展活动度优于锁骨钩钢板组。锁骨钩钢板组易出现肩关节疼痛及肩关节活动受限。在切口感染及内固定松动方面两组差异无统计学意义。术后根据Karlsson评定标准，双Endobutton钢板组优14例，良3例，差1例，优良率为95％；锁骨钩钢板组优9例，良6例，差5例，优良率为75％。结论双Endobutton钢板在治疗RockwoodⅢ～Ⅴ型肩锁关节脱位的总体疗效与锁骨钩钢板相当，但是其术后肩关节疼痛及肩关节活动受限发生率低，有利于早期进行功能锻炼。

Objective To evaluate and compare the outcomes of double Endobutton and clavicular hook plate for the treatment of Rockwood type Ⅲ～Ⅴ acromioclavicular joint dislocation. Methods From February 2008 to December 2008, 38 patients with Rockwood type Ⅲ～Ⅴ acromioclavicular joint dislocation were treated with double Endobutton （18 patients, including 12 males and 6 females, with the mean age of 38.5±6.2 years） and AO clavicular hook plate （20 patients, including 14 males and 6 females, with the mean age of 34.8±5.9 years） respectively. The difference between the 2 groups was not significant in preoperative evaluation and comparability existed. The indexes of perioperation and duration of hospital stay, the radio- graphic outcomes, the clinical outcomes and postoperative complications were statistically compared. Results Duration of operation, blood loss perioperation were significantly less in clavicular hook plate group; howev- er, the average incision length was significantly shorter in double Endobutton group. Double Endobutton group resulted in a less shoulder pain and a better shoulder motion （statistically significant）, but there was no statistical difference on the rate of good and fair between the two groups. There were also no significant dif- ferences between the two groups with regard to infection and loose of internal fixation. Conclusion Double Endobutton is believed to be as good as clavicular hook plate for the treatment of Rockwood type llI-V acromioclavicular joint dislocation. However, with double Endobutton, patients can get less shoulder pain and better shoulde motion, which is in favor of early exercise. Because of good biocompatibility, double Endobutton can be retained in body long-term and need not to be removed.