三重带袢钢板技术治疗新鲜RockwoodⅢ型肩锁关节脱位手术创伤与临床疗效相关性研究

Correlation study of surgical trauma and clinical efficacy of triple Endobutton technique in the treatment of fresh Rockwood typeⅢacromioclavicular dislocation

目的对比AO锁骨钩钢板和三重带袢钢板技术治疗新鲜RockwoodⅢ型肩锁关节脱位患者手术创伤和临床疗效指标,并进一步在优势组中行相关性分析,探究优势组中影响临床疗效相关因素,为此类疾病手术治疗改进提供借鉴.方法回顾性分析惠州市第一人民医院自2018年1月至2020年5月符合新鲜RockwoodⅢ型肩锁关节脱位患者72例,根据手术方式不同分为AO组(A组)和三重Endobutton带袢钢板组(B组).其中A组(n=37,F/M=12/25),平均年龄(41.30±1.02)岁;B组(n=35,F/M=13/22),平均年龄(43.36±1.15)岁.所有患者术后1 d、1周、1个月、3个月、1年均行X线检查.X线中测量喙锁间距、肩锁间距评估手术复位,视觉模拟评分(visual analogue scale/score,VAS)和Constant-Murley肩关节功能评分评估临床疗效.通过Graphpad Prism 7软件进行数据分析.年龄、返工时间、受伤至手术花费时间、手术持续时间、手术切口长度、术中出血量、VAS评分、Constant-Murley肩关节功能评分、喙锁间距和肩锁间距采用x-±s表示;性别、受伤位侧采用数量表示.计量资料组间比较用t检验分析,计数资料组间用卡方检验分析,相关性分析均采用Pearson相关性分析,P<0.05为差异具有统计学意义,r>0为正相关.结果72例患者依据12个月随访,Constant-Murley肩关节功能评分结果:A组术后1 d(46.60±0.41)分、术后1周(65.22±0.45)分和B组术后1 d(51.30±0.39)分、术后1周(75.07±0.35)分相比较,术后1 d和术后1周A组分数均明显小于B组,差异具有统计学意义(P<0.05).VAS结果提示:A组术后1 d(6.71±0.07)分、术后1周(5.45±0.09)分、术后1个月(3.70±0.11)分和B组术后1 d(5.70±0.10)分、术后1周(3.60±0.14)分、术后1个月(2.00±0.10)分相比较,A组分数均明显大于B组,差异具有统计学意义(P<0.05).返工时间结果示:A组(7.64±0.10)周明显长与B组(6.01±0.17)周,差异有统计学意义(P<0.05).相关性提示:B组手术切口长度与术后1 dVAS评分(r=0.73,P<0.05)和术后1周VAS评分(r=0.68,P<0.05)均呈正相关.结论带袢钢板和锁骨钩钢板技术治疗肩锁关节脱位远期疗效相当,但相较于锁骨钩钢板内固定术而言,带袢钢板具有手术切口小、出血量少、伤口外观更好,并且在早期恢复中疼痛缓解、肩关节功能恢复更快等优势,在术后早期恢复中,带袢钢板技术通过减小手术创伤缩短患者术后疼痛时间,临床值得推广.

Background Acromioclavicular joint dislocation is a clinically common disease and caused by trauma violence.Patients often felt severe shoulder pain with limited mobility,seriously affecting daily life and work.Rockwood classification was mostly used in this disease.Because of its dislocation severity,damage structure characteristics and other reasons,the clinical treatment options of type III patients are often controversial.Fresh Rockwood Ⅲ-Ⅳ type patients are clinically taken more surgical treatment,but the method is different.With the progress of materials and surgical concepts,new surgical techniques are becoming more widely used,and choosing a treatment that patients with this disease could get more benefits is a key issue for surgeons.Objective By collecting and comparing the surgical trauma and clinical efficacy indexes of AO clavicular hook plate and triple Endobutton technique in the treatment of fresh Rockwood type Ⅲ acromioclavicular dislocation,the correlation analysis was further carried out in the dominant group to explore the factors affecting the clinical efficacy,so as to provide reference for the improvement of surgical treatment of this kind of disease.Methods From January 2018 to May 2020,the data of 72 patients with fresh Rockwood type Ⅲ acromioclavicular dislocation were retrospectively analyzed.The patients were divided into AO clavicular hook plate group(Group A) and triple Endobutton group(Group B) according to the different operation methods.In Group A(n=37,F/M=12/25),the average age was(41.30±1.02) years,and in the Group B(n=35,F/M=13/22),the average age was(43.36±1.15)years.The X-ray examinations were performed on the 1 st day,1 st week,1 st month,3 rd month and 1 year after surgery.Coracoclavicular joint distance and acromioclavicular joint distance were measured to evaluate the surgery reduction.The visual analogue scale(VAS) and Constant-Murley score were used to evaluate the clinic efficacy.The data were analyzed with Graphpad Prism 7 software.The age,rework time,injury to operation time,duration of surgery,surgical incision length,intraoperative blood loss,VAS score,ConstantMurley score,acromioclavicular joint distance and coracoclavicular joint distance were expressed as x±s.The gender and injured side were expressed quantitatively.The measurement data comparison among groups was analyzed by t test.The Chi-square test analysis and correlation analysis of enumeration data between groups was analyzed by Pearson correlation analysis.A value of P< 0.05 was considered statistically significant,and r> 0 was considered positively correlated.Results Seventy two cases were followed up for 12 months.The results of Constant-Murley scores in Group A on the 1 st day(46.60±0.41) and 1 st week(65.22±0.45) after surgery were statistically significant lower(P <0.05) than those in Group B on the1 day(51.30±0.39) and 1 st week(75.07±0.35) after surgery.The results of VAS scores in Group A on the 1 st day(6.71±0.07),1 st week(5.45±0.09) and 1 st month(3.70±0.11) after surgery were statistically significant higher(P <0.05) than those in Group B on the 1 st day(5.70±0.10),1 st week(3.60±0.14) and 1 st month(2.00±0.10) after surgery.The results of rework time in Group A(7.64±0.10) week were statistically significant longer(P<0.05) than those in Group B(6.01±0.17) week Finally,it was positive correlation between 1 day after surgery VAS scores(r=0.73,P <0.05) and surgical incision length,the same results were found between 1 week after surgery VAS scores(r=0.68,P <0.05) and surgical incision length.In group B,the incision length was positively correlated with VAS score of 1 st day(r=0.73,P <0.05) and 1 st week(r=0.68,P <0.05)after surgery.Conclusion The long-term effect of Endobutton technique and clavicular hook plate in the treatment of acromioclavicular joint dislocation is comparable.However,the advantages of Endobutton technique include small incision,less blood loss,better looking wound,pain relieve during early rehabilitation and fast restoration.In early postoperative recovery,Endobutton technique can shorten postoperative pain duration by reducing surgical trauma,which is worthy of clinical promotion.