改良弹性固定治疗急性肩锁关节脱位的近期疗效观察

Short-term clinical effect of modified elastic fixation in the treatment of acute acromioclavicular joint dislocation

目的探讨改良弹性固定(改良Endobutton带袢钛板内固定术)治疗急性肩锁关节脱位的近期临床疗效。方法回顾性队列研究。纳入2020年1月—2021年10月南通大学附属南京江北医院骨科收治的RockwoodⅢ、Ⅳ型急性肩锁关节脱位的患者46例。按照手术方案不同分组:Endobutton改良组19例,男11例、女8例,年龄25~66(40.1±10.8)岁,左侧4例、右侧15例,Ⅲ型7例、Ⅳ12例,采用改良Endobutton带袢钛板内固定治疗;肩锁钩钢板组27例,男16例、女11例,年龄20~67(36.4±10.0)岁,左侧7例、右侧20例,Ⅲ型11例、Ⅳ16例,采用肩锁钩钢板内固定治疗。观察指标:比较2组患者的手术时间、切口长度及术中出血量,1、3、6个月时肩关节功能ConstantMurley评分,肩关节疼痛视觉模拟评分法(VAS)评分及术后并发症的发生情况。结果2组患者性别、年龄、侧别、致伤原因、Rockwood分型及受伤至手术时间等基线资料比较,差异均无统计学意义(P值均>0.05)。2组患者均顺利完成手术且获得大于6个月的随访。Endobutton改良组患者手术时间为(55.5±4.8)min、长于肩锁钩钢板组的(42.6±5.5)min,术中出血量为(33.7±7.1)mL、少于肩锁钩钢板组的(56.5±10.5)mL,切口长度为(4.6±1.5)cm、短于肩锁钩钢板组的(6.6±1.4)cm,差异均有统计学意义(t=8.23、-8.21、-4.69,P值均<0.001)。2组患者术后1、3、6个月Constant-Murley评分及VAS评分均较术前明显改善,差异均有统计学意义(P值均<0.05)。术后1、3个月,Endobutton改良组Constant-Murley评分均高于肩锁钩钢板组[(79.9±7.0)分对(72.4±8.3)分,(85.8±8.9)分对(80.5±8.5)分],VAS评分均低于肩锁钩钢板组[(3.1±1.0)分对(3.9±1.3)分,2(2,3)分对3(2,3)分],差异均有统计学意义(P值均<0.05);术后6个月,Endobutton改良组和肩锁钩钢板组的VAS评分分别为1(1,2)分、1(1,1)分,Constant-Murley评分分别为(93.6±3.9)分、(92.6±4.3)分,差异均无统计学意义(P值均>0.05)。随访期间,Endobutton改良组并发症发生率(2/19)低于肩锁钩钢板组(29.63%,8/27),差异无统计学意义(χ^(2)=1.40,P=0.237)。结论相较于肩锁钩钢板内固定,改良Endobutton带袢钛板内固定治疗急性肩锁关节脱位的近期临床疗效更优,其切口更小、术中出血量更少、肩关节功能恢复更好、术后出现并发症概率更小,但手术时间相对更长。

Objective This study aimed to investigate the short-term clinical effect of modified elastic fixation(modified Endobutton loop titanium plate)in the treatment of acute acromioclavicular dislocation.Methods This was a retrospective cohort study.A total of 46 patients with Rockwood typesⅢandⅣacute acromioclavicular joint dislocation admitted to the Department of Orthopedics,Nanjing Jiangbei Hospital Affiliated to Nantong University from January 2020 to October 2021 were included in this study.Herein,19 patients were included in the Endobutton improvement group,and the modified Endobutton loop titanium plate internal fixation was used,including 11 males and 8 females,aged 25-66(40.1±10.8)years;4 patients on the left side and 15 on the right;and typesⅢandⅣwith 7 and 12 patients,respectively.Meanwhile,27 patients treated with acromioclavicular hook plate internal fixation were included in the acromioclavicular hook plate group,including 16 males and 11 females,aged 20-67(36.4±10.0)years;7 patients on the left side and 20 on the right;and typesⅢandⅣwith 11 and 16 patients,respectively.Observation indicators include the operation time,incision length,intraoperative blood loss,Constant-Murley score of shoulder joint function,and a visual analog scale score of shoulder joint pain at 1,3,and 6 months after the operation.Postoperative complications were recorded and analyzed in the two groups.Results There was no significant difference in baseline clata between the two groups(all P values>0.05).All patients in the two groups successfully completed the operation and were followed up for more than 6 months.The operation time in the Endobutton improved group was(55.5±4.8)min,longer than that in the acromioclavicular plate group(42.6±5.5)min,the intraoperative blood loss was(33.7±7.1)mL,less than that in the acromioclavicular plate group(56.5±10.5)mL,and the incision length was(4.6±1.5)cm.The differences were statistically significant(t=8.23,−8.21,−4.69,all P values<0.001).At 1,3,and 6 months after the operation,the two groups were significantly improved compared with the Constant-Murley score of the shoulder joint and VAS score,and the differences were statistically significant(all P values<0.05).At 1 and 3 months after the operation,the Constant-Murley score in the Endobutton improvement group was higher than that in the acromioclavicular hook plate group([79.9±7.0]vs.[72.4±8.3]and[85.8±8.9]vs.[80.5±8.5]),and VAS scores in the Endobutton improvement group were lower than that of the acromioclavicular hook plate group{(3.1±1.0)vs.(3.9±1.3)and(2[2,3])vs.(3[2,3])},and statistical significance was observed(all P values<0.05);6 months after the surgery,VAS scores in both groups were 1(1,2)and 1(1,1),respectively,and Constant-Murley scores were(93.6±3.9)and(92.6±4.3),respectively,with no statistical significance(all P values>0.05).The incidence of complications in the Endobutton improvement group(2/19)was lower than that in the acromioclavicular plate group(29.63%,8/27),but the difference was not statistically significant(χ^(2)=1.40,P=0.237).Conclusion Compared with acromioclavicular hook plate internal fixation in the treatment of acute acromioclavicular joint dislocation,the modified posterior Endobutton loop titanium plate internal fixation has better short-term clinical efficacy,with shorter incision,less intraoperative blood loss,better recovery of shoulder joint function,and less postoperative complications.However,the operation time is relatively longer.