Endobutton带袢钛板与钩钢板治疗肩锁关节脱位的病例对照研究

Case-control study on the Endobutton plate and clavicular hook plate for the treatment of acromioclavicular joint dislocation

目的:比较Endobutton带袢钛板与锁骨钩钢板治疗肩锁关节脱位的临床疗效及并发症。方法:回顾性2015年3月至2019年5月手术治疗的RockwoodⅢ-Ⅴ型肩锁关节脱位患者48例,按照手术方法不同分为两组。其中23例采用Endobutton带袢钛板固定治疗(观察组),男15例,女8例;年龄23~59(36.2±8.1)岁;RockwoodⅢ型6例,Ⅳ型11例,Ⅴ型6例。25例采用锁骨钩钢板治疗(对照组),男17例,女8例;年龄22~54(34.7±6.4)岁;RockwoodⅢ型6例,Ⅳ型14例,Ⅴ型5例。比较两组患者手术时间,术中出血量,住院天数,疼痛视觉模拟评分(visual analogue scale,VAS),肩关节功能Connstant-Murley评分及术后并发症情况。结果:两组患者术后均获得随访,时间24~51(30.5±6.5)个月。观察组术中出血量、住院天数分别为(71.9±4.0)ml,(8.2±1.6)d;对照组分别为(97.6±13.4)ml,(12.8±1.2)d;两组比较差异有统计学意义(P<0.05)。两组手术时间比较差异无统计学意义(P>0.05)。观察组术后即刻、术后12个月VAS评分分别为(4.00±0.39)、(1.58±0.13)分,与对照组(7.32±0.43)、(3.09±0.23)分比较差异有统计学意义(P<0.05);观察组术后即刻、术后12个月肩关节功能Connstant-Murley评分为(59.65±0.15)、(85.97±0.73)分,与对照组(52.77±0.19)、(55.78±0.19)分比较差异有统计学意义(P<0.05)。观察组发生肩部疼痛1例,异位骨化1例;对照组发生内固定失败1例,肩峰撞击3例,肩部疼痛3例,异位骨化3例;两组比较差异有统计学意义(P<0.05)。结论:Endobutton带袢钛板内固定技术相比锁骨钩钢板内固定治疗肩锁关节脱位,具有手术出血少、住院天数短、术后疼痛轻、肩关节功能恢复好、并发症少等优势。

Objective:To study the clinical efficacy and complications of Endobutton titanium plate and clavicle hook plate in the treatment of acromioclavicular dislocation.Methods:Total 48 patients with Rockwood Ⅲ to Ⅴ acromioclavicular joint dislocation from March 2015 to May 2019 were retrospectively divided into two groups according to different surgical methods.Among the patients,23 patients were treated with Endobutton loop titanium plate fixation(observation group),ineluding 15 males and 8 females,ranging in age from 23 to 59 years old,with an average of(36.2±8.1) years old;Rockwood typeⅢ in 6 cases,type Ⅳ in 11 cases and type V in 6 cases.Twenty-five patients were treated with clavicular hook plate(control group) including 17 males and 8 females,ranging in age from 22 to 54 years old,with an average of(34.7±6.4) years old;Rockwood type Ⅲ in 6 cases,type Ⅳ in 14 cases and type V in 5 cases.The operation time,intraoperative bleeding,hospitalization time,visual analogue scale(VAS) of pain,Constant-Murley score of shoulder function and postoperative complications were compared between the two groups.Results:All the patients were followed up,and the duration ranged from 24 to 51 months,with a mean of(30.5±6.5) months.The amount of bleeding and hospitalization time in the observation group were(71.9±4.0) ml and(8.2±1.6) d respectively;and those in the control group were(97.6±13.4) ml and(12.8±1.2) d respective-1 y.There was significant difference between the two groups(P<0.05).There was no significant difference in operation time between the two groups(P>0.05).The VAS scores of the observation group immediately after operation and 12 months after operation were 4.00±0.39 and 1.58±0.13 respectively,which were statistically significant compared with 7.32±0.43 and 3.09±0.23 in the control group(P<0.05).The Constant-Murley scores of shoulder function in the observation group were 59.65±0.15 and85.97±0.73 immediately and 12 months after operation,which were significantly different from those in the control group52.77±0.19 and 55.78±0.19(P<0.05).In the observation group,there were 1 case of shoulder pain and 1 case of ectopic ossification;in the control group,there were 1 case of internal fixation failure,3 cases of acromion impact,3 cases of shoulder pain and 3 cases of ectopic ossification.There was significant difference between the two groups(P<0.05).Conclusion:Compared with clavicular hook plate internal fixation in the treatment of acromioclavicular joint dislocation,Endobutton loop titanium plate internal fixation technology has the advantages of less surgical bleeding,shorter hospitalization time,less postoperative pain,good recovery of shoulder joint function and less complications.