改良双Endobutton技术治疗TossyⅢ型肩锁关节脱位的远期疗效分析

Analysis on the long term effects of modified double Endobutton technique in the treatment of Tossy type Ⅲ acromio- clavicular joint dislocations

目的：采用改良双Endobutton技术对Tossy Ⅲ型肩锁关节脱位进行治疗，并研究其远期的临床疗效。方法：对2008年12月至2010年12月采用改良双Endobutton技术治疗Tossy Ⅲ型肩锁关节脱位的患者进行回顾性研究。42例患者，其中男24例，女18例；年龄21～56岁，中位年龄32.5岁。所有患者行切开复位，肩锁韧带采用Ethibond线缝合修复或带线锚钉重建，喙锁韧带采用双Endobutton技术重建进行治疗。临床疗效采用Karlsson标准进行评价，喙锁间隙距离以2块Endobutton钢板的中心连线距离来代替，通过影像学上测量喙锁间隙距离来评估复位丢失情况。结果：42例患者均获随访，时间2.0～3.2年，平均2.4年。术后3个月按照Karlsson疗效标准评定，A级32例，B级10例；末次随访时A级26例，B级16例，6例从A级降为B级。术后3个月喙锁间隙距离（26.91±0.91） mm，末次随访（27.41±1.10） mm，差异有统计学意义（P〈0.05），其中术中过度复位和术后从事体力劳动的患者其间隙距离增加更明显。另外，所有患者在锁骨侧Endobutton周围都存在一定的骨质吸收，但范围不大。结论：改良双Endobutton技术可以有效重建肩锁韧带及喙锁韧带，从而获得良好的早期临床效果，但随时间的延长会逐渐出现复位的部分丢失及钢板周围的骨质吸收，部分患者临床疗效也会有所下降，但患者对临床结果仍满意。

Objective： To investigate the long-term clinical effects of modified double Endobutton technique for the treatment of acromioclavicular joint dislocations of Tossy type Ⅲ. Methods： A retrospective study was done in 42 patients with acromioclavicular joint dislocations of Tossy type Ⅲ treated with modified double Endobutton technique from December 2008 to December 2010. There were 24 males and 18 females,ranging in age from 21 to 56 years old（averaged,32.5 years old）. All the patients were treated with open reduction,coracoclavicular ligament reconstruction using double Endobutton technique,and repair of acromioclavicular ligament. The Karlsson system was used to evaluate therapeutic effects. The distance from coracoid to clavicle was measured to evaluate reduction loss. Results： All the patients were followed up,and the duration ranged from 2.0 to 3.2 years（averaged,2.4 years）. According to Karlsson system,32 patients got an A degree and 10 patients got a B degree at three months post-operatively;26 patients got an A degree and 16 patients got a B degree at the latest follow-up;6 patients got an A degree at 3 months after operation lowered to B degree at the latest follow-up. The coracoid-clavicle distance increased from（26.91±0.91） mm at 3 months after operation to（27.41±1.10） mm at the latest follow-up. Te patients treated with over-reduction during operation or with heavy physical labour work after operation had obvious widened coracoid-clavicle distance. Bone absorption was found around the plate in most cases,mainly in the clavicular side. Conclusion： Treatment for acromioclavicular joint dislocations of Tossy type Ⅲ with modified double Endobutton technique has satisfactory early clinical results. But with time passing,loss of reduction and bone absorption around the plate could be observed,and clinical outcomes of some cases downgrade during the long-term follow-up.