改良与经典双纽扣钢板技术治疗肩锁关节脱位的临床疗效比较

Comparison of clinical efficacy of modified and classic double Endobutton techniques in treatment of severe acromioclavicular joint dislocation

目的对经典双纽扣钢板技术进行改良,并比较改良双纽扣钢板技术与经典双纽扣钢板技术治疗RockwoodⅢ型及以上肩锁关节脱位的临床疗效。方法回顾性分析广东医科大学附属医院骨科中心2015年1月至2017年1月收治的26例RockwoodⅢ型及以上肩锁关节脱位患者临床资料。纳入病例均为肩关节X片提示锁骨外端移位,肩锁关节间隙增大,肩锁关节完全脱位。其中采用经典双纽扣钢板技术手术治疗14例设为经典组,采用改良双纽扣钢板技术手术治疗12例设为改良组,比较两组患者手术时间、出血量、切口长度、并发症及术后肩关节功能恢复情况等。并发症发生率和术后关节功能优良率等计数资料采用卡方检验,切口长度、术中失血量及手术花费时间等计量资料采用t检验。结果两组切口长度接近,肩关节功能恢复情况、并发症发生率与改良组基本一致。改良组手术持续时间明显短于经典组(t=6.18,P<0.01);改良组术中失血量(48.7±6.5)ml明显少于经典组(57.8±7.7)ml,差异有统计学意义(t=6.01,P<0.01)。结论改良双纽扣钢板技术创伤小,固定牢靠,操作方便,术中出血量明显减少,手术时间明显缩短,但短期内改善肩关节功能方面并没有优于经典组。

Objective To compare the clinical efficacy between the modified double Endobutton technique and the classical double Endobutton technique on the treatment of Rockwood type III acromioclavicular joint dislocation or greater. Methods Twenty-six patients with Rockwood type III injury and above this level were randomly treated with the modified double Endobutton technique（12 patients） or the classical double Endobutton technique（14 patients） from Jan 2015 to Jan 2017. The operation time,bleeding volume,the incision length,the incidence of post-operative compilations and recovery of the shoulder function of all patients were recorded and compared. The complications and postoperative joint functions were compared using chi-square test. The length of incision,intraoperative blood loss and operation time were measured by t-test. Results Compared with the classic group,the length of the incision was similar in the modified group,and the incidence of complications were basically the same as those in the modified group. Although the function recovery of the shoulder joint was better in the classical group,the duration of surgery（t = 6. 18,P 〈 0. 01） and blood loss,which was（48. 7 ± 6. 5） ml in the modified group were significantly less than（57. 8 ± 7. 7） ml in the classic group（t = 6. 01,P 〈 0. 01）. The differences were statistically significant between the two groups. Conclusion The improved double-button plate technique has less trauma, firm fixation, convenient operation, significantly reduced intraoperative blood loss, and significantly shorter operative time,but it does not improve shoulder function in the short term better than the classic group.