关节镜下四袢与双袢固定修复急性肩锁关节Rockwood V型脱位疗效对比研究

Comparative effectiveness research of arthroscopic four-loop fixation versus double-loop fixation for treatment of acute acromioclavicular joint dislocation of Rockwood type V

目的对比评估双骨道四袢与单骨道双袢固定修复急性肩锁关节RockwoodⅤ型脱位疗效。方法回顾性分析2010年5月至2016年5月于深圳大学第一附属医院接受关节镜下双骨道四袢与单骨道双袢固定修复急性肩锁关节RockwoodⅤ型脱位的所有患者,其中入选82例手术患者,四袢双骨道组与双袢单骨道组各41例。术后2年内随访观察患者的视觉模拟评分(visual analogue scale,VAS)、患者恢复运动时间、恢复运动患者数量、Constant功能评分、Karlsson肩锁关节功能评分,并通过影像学观察评估喙锁关节和肩锁关节的间隙。结果术后2年内末次随访X线片显示四袢双骨道组患侧平均喙锁关节和肩锁关节的间隙与双袢单骨道组对比明显减小,且差异具有统计学意义(P<0.05);双袢单骨道组患者健侧平均喙锁关节和肩锁关节的间隙与患侧对比明显减小,且差异具有统计学意义(P<0.05);然而四袢双骨道组患者健侧平均喙锁关节和肩锁关节的间隙与患侧对比差异无统计学意义(P>0.05)。两组患者术后末次随访患肢疼痛均有明显减轻,术前与术后VAS评分对比差异具有统计学意义,两组组间对比差异无统计学意义。四袢双骨道组重返运动的时间较双袢单骨道组明显缩短,重返患者数目明显多于双袢单骨道组,且Constant功能评分、Karlsson肩锁关节功能评分均明显优于双袢单骨道组,差异均具有统计学意义(P<0.05)。四袢双骨道组并发症明显少于双袢单骨道组。结论采用关节镜下双骨道四袢固定治疗Rockwood V型脱位,方法固定可靠,并发症少,较双袢单骨道固定效果更佳,是治疗急性肩锁关节Rockwood V型脱位损伤较好的方法。

Background The treatment of acromioclavicular(AC)joint dislocation is mainly based on the Rockwood classification.For acute acromioclavicular joint dislocations severer than Rockwood type III,surgical treatment is often required.The Rockwood type V injuries are common,but the surgical treatment methods are controversial.The common surgical procedures include clavicular hook plate.In 2007,Struhl reported the first case of using loop plate Endobutton device for treatment of AC joint dislocation in open surgery.Several scholars have also used double-loop to fix the AC joint dislocation under arthroscopy,and achieved satisfactory results.The Endobutton plate could be confirmed located at the base of coracoid process under arthroscopy,which was relatively safer compared to open surgery.Not only that,arthroscopy can also diagnose and deal with other problems.However,the fixation methods are numerous,including double-loop fixation,four-loop fixation and triple-loop fixation,and the more commonly seen are double-loop and four-loop fixation.The efficacy of double-loop fixation versus four-loop fixation has not been compared.Objective This study aims to evaluate and compare the efficacy of four-loop fixation through double bone tunnels versus double-loop fixation through single tunnel for treatment of acute AC joint dislocation of Rockwood type V.Methods We retrospectively reviewed the charts of patients with acute AC joint dislocation of Rockwood type V who had undergone arthroscopic double-loop fixation through single bone tunnel and four-loop fixation through double bone tunnels from May 2010 to May 2016.Eighty-two patients were included and divided into two groups according to different fixation types with 41 cases in each group.The patients were followed up for 2 years,and the visual analog scale(VAS)score,time of return to activities,number of patients return to activities,Constant-Murley scores as well as Karlsson were recorded as well.The Space between the coracoclavicular(CC)joint and AC joint was evaluated by imaging.Results The average CC joint and AC joint distances in the double paired Endobutton(DPE)group were significantly smaller than those of the single paired Endobutton(SPE)group in the last follow up within two years after operation(P<0.05).The average AC and CC distances in the healthy shoulder joints were significantly smaller than those of the affected joints in the SPE group(P<0.05).However,these values were not significantly different from those of the affected joints in the DPE group(P>0.05).In the last postoperative follow-up,the pain of the affected limb was significantly reduced in both groups,and there was a significant difference between preoperative and postoperative VAS scores,while there was no significant difference between the two groups.The time of returning to exercise was significantly shorter in the DPE group than in the SPE group,and the number of patients returning to exercise was significantly more than that in the SPE group.The Constant scores and Karlsson scores were significantly higher in the DPE group t han in the SPE group,and the difference was statistically significant(P<0.05).The complications in the DPE group were less than those in the SPE group.Conclusions Compared with the SPE group,the DPE group achieved better outcome with less complications in the treatment of acute AC joint dislocation of Rockwood type V under arthroscopy.