关节镜辅助带袢微钢板治疗肩锁关节脱位疗效观察

Arthroscopically assisted double Endobutton fixaton technique for the treatment of acute acromioclavicular joint dislocation

目的随着微创理念的不断深入以及关节镜技术的快速普及,关节镜技术在肩锁关节脱位的微创治疗中逐渐得到推广,其有效性及安全性不断得到验证。文中探讨关节镜辅助双Endobutton带袢钢板治疗RockwoodⅢ型及以上的急性肩锁关节脱位临床疗效。方法收集2013年11月至2014年12月期间广西医科大学附属医院收治的23例肩锁关节脱位患者,其中男14例,女9例。按照Rockwood分型,Ⅲ型9例,Ⅳ10例,Ⅴ型4例。所有患者均采用关节镜辅助双Endobutton带袢钢板治疗,对手术前与末次随访肩关节外展上举、前屈上举关节活动度、疼痛视觉模拟评分（visual analogue score,VAS）及日本整形外科协会（Japanese Orthopaedic Association,JOA）评分进行统计分析。同时拍摄双肩关节正位片对比了解复位是否丢失。结果术后平均随访（9.3±2.4）个月（6-18个月）,受伤至手术时间2-20 d,平均（10.1±3.2）d,手术前后肩关节JOA平均评分分别为[（71.0±5.4）分vs（93.5±3.6）分];手术前后VAS平均评分分别为[（4.6±1.0）分vs（1.9±0.9）分];手术前后患者手术肩关节平均前屈上举[（102.5±8.6）°vs（144.3±6.3）°]、平均外展上举[（107.1±6.2）°vs（149.6±7.5）°]。所有患者JOA与VAS评分以及肩关节活动度明显优于术前（P〈0.05）。术后4周2例患者出现复位丢失,经限制肩关节2周后锁骨上移位不再增加,肩关节功能较术前满意。结论关节镜辅助双Endobutton带袢钢板治疗急性肩锁关节脱位可获得有效固定,并可改善肩关节功能。

Objective With the development of minimally invasion and the popularization of arthroscopy the technology of arthroscopy has been widely applied for the treatment of acute and the safety of this has been validated. To analyze the clinical effect of arthroscopically assisted double Endobutton plate reconstruction of coracoclavicular ligament in the treatment of acute acromioclavicular joint dislocation. Methods From November 2013 to December 2014,a total of 23 patients with Rockwood type III,Ⅳ,Ⅴshoulder joint dislocation were included,all cases was treated by arthroscopic double Endobutton fixaton technique. Patients were followed up for 6 to 18 months. The changes of shoulder joint forward elevation and external rotation,Japanese Orthopaedic Association score（ JOA）,and Visual Analogue score（ VAS） of acromioclavicular joint in both perioperative and postoperative were recorded. Results The mean follow-up time was（ 9. 3 ± 2. 4） months（ range from 6 to 18 months）,and mean time from injury to surgery was（ 10. 1 ± 3. 2） days. The therapeutic effects were achieved in all patients after the arthroscopically assisted double Endobutton plate reconstruction. All the measurements,including the mean forward elevation JOA scores before and after fixation（ 71. 0 ± 5. 4 vs 93. 5 ± 3. 6）,and mean VAS scores（ 4. 6 ± 1. 0 vs1. 9 ± 0. 9）,mean forward elevation [（ 102. 5 ± 8. 6） degrees vs（ 144. 3 ± 6. 3） degrees],and mean external rotation[（ 107. 1 ± 6. 2） degrees vs（ 149. 6 ± 7. 5） degrees] improved significantly（ P〈0. 05）after the treatment. Conclusion Arthroscopic double Endobutton fixaton technique could provide an effective immobilization of shoulder and acromioclavicular joint,thus improving the function of the joint and achieving an excellent effect in the treatment of acute acromioclavicular joint dislocation.