带袢钢板治疗肩锁关节完全性脱位的疗效及其影响因素

The results and effect factors of endobutton technique for complete acromioclavicular joint dislocation

目的探讨带袢钢板技术在治疗完全性肩锁关节脱位的疗效及其影响疗效的因素。方法对26例肩锁关节脱位患者采用带袢钢板技术进行手术治疗。摄X线片测量袢钢板距离锁骨远端的相对距离[锁骨袢钢板中点到锁骨远端长度(L1)/锁骨长度(L)]术后6个月复位的丢失量。采用Constant肩关节评分法进行功能评估。结果 26例均获良好的复位。术后3 d喙锁距离为(28.41±4.14)mm,6个月时为(29.71±4.18)mm,平均丢失(1.30±1.18)mm。锁骨的袢钢板固定点和锁骨外缘的相对距离为0.21±0.03。Constant肩关节评分:术前为(30.65±6.18)分,术后为(91.03±5.21)分(t=-38.12,P<0.001)。结论带袢钢板技术是一种非刚性固定肩锁关节的方式,闭合袢材料的生物力学足以维持肩锁关节的复位,术后疗效满意。骨道的定位、合适长度的袢钢板选择和术后正确的康复是减少术后复位丢失的重要因素。

Objective To observe the results of endobutton technique for complete acromioclavicular（AC） joint dislocation and analysis effect factors.Methods Double endobuttons technique was used to treat 26 cases of AC joint complete dislocation.Loss of reduction was evaluated by evaluating the change of distance between coracoid and clavicle at the time of operation and that of 6 months postoperatively.Meanwhile,the relative length from the fixator to the distal end of clavicle as L1/L（L1 meant the length from the upper endnobutton midpoint to the proximal end of clavicle,and L meant the whole length of clavicle） were figured up.The patients were evaluated based on Constant score.Results All the 26 cases had got good reduction after the operation.The average distance between coracoid and clavicle was（28.41±4.14） mm three days after the operation.And it changed to（29.71±4.18） mm six months postoperatively.The amount of average reduction loss was（1.30±1.18） mm.L1/L was 0.21±0.03.The average Constant score was（30.65±6.18） preoperatively,and（91.03±5.21） postoperatively（t=-38.12,P0.001）.Conclusions Endobutton technique is a kind of non-rigid fixation method.The close loop provids enough strength to maintain the reduction of AC joint.Patients can get good results.The position of the bone tunnel,the length of close loop and the proper rehabilitation are the important factors to effect the reduction loss postoperatively.