非镜下专用定位/复位器辅助袢钢板治疗锁骨远端骨折和肩锁关节脱位的疗效分析

Therapeutic effect analysis of non-arthroscopic special positioning/reduction device assisted double Endobutton in the treatment of distal clavicular fractures and acromioclavicular dislocations

目的探讨非镜下专用定位/复位器辅助袢钢板治疗锁骨远端骨折和肩锁关节脱位的疗效分析。方法对2020年1月至2023年7月间应用微创小切口非镜下专用定位/复位器辅助袢钢板治疗的38例锁骨远端骨折和肩锁关节脱位患者进行回顾性研究分析。其中男26例、女12例,平均年龄(45.34±14.67)岁,平均术后随访(22.18±17.91)个月,肩锁关节脱位33例(Rockwood分型:Ⅲ型4例、Ⅴ型29例)、锁骨远端骨折5例,均为NeerⅤ型。比较患侧与健侧肩关节治疗前和治疗后1周、1个月、3个月、半年、1年的Constant评分、美国加州大学(University of Caliornia at LosAngeles,UCLA)肩关节评分系统、视觉模拟评分(visual analogue scale,VAS)及患侧肩并发症发生情况。结果患者术后1个月内症状减轻明显,患侧术后1周与术前、术后1个月与术后1周的VAS疼痛评分差异有统计学意义(P<0.05),术后功能评分获得明显改善,并立即获得良好的稳定性。患侧术后1周与术前、术后1个月与术后1周、术后3个月与术后1个月、术后半年和术后3个月的Constant评分差异有统计学意义(P<0.05),患侧术后1周与术前、术后1个月与术后1周、术后3个月与术后1个月的UCLA评分差异有统计学意义(P<0.05)。患侧与健侧的Constant评分和UCLA评分在治疗前与治疗后随访差异均有统计学意义(P<0.05)。结论使用非镜下喙锁韧带重建专用定位/复位器辅助袢钢板悬吊固定治疗锁骨远端骨折和肩锁关节脱位,可实现快速准确固定、快速康复、并发症少、学习曲线短、易于广泛普及。

Background Clavicular fractures involving the distal end represent approximately 21%to 28%of all clavicular fractures.Conservative treatment for such fractures has shown non-union rates ranging from 22%to 50%.Hence,surgical intervention is currently recommended.Acromioclavicular joint dislocations account for approximately 12%of shoulder joint injuries.Conservative management of severe dislocations results in residual pain and restricted shoulder joint mobility,while superior displacement deformities of the distal clavicle significantly affect aesthetics.The treatment approach for distal clavicular fractures and acromioclavicular joint dislocations is similar.However,previously utilized methods such as hook plates,clavicular hooks,and Kirschner wire fixation have shown higher complication rates and suboptimal clinical outcomes.With the advancement in sports medicine,using a strut plate suspension fixation to reconstruct the coracoclavicular ligaments has become a crucial method for treating distal clavicular fractures and acromioclavicular joint dislocations.Traditionally performed arthroscopically,this method presents a steep learning curve and is unavailable in hospitals without shoulder arthroscopy,limiting its widespread adoption.Additionally,due to locator design issues,off-center clavicular and coracoid bone tunnels may lead to tunnel cutting,causing iatrogenic fractures of the clavicle and coracoid process,resulting in reconstruction failure.Objective To investigate the therapeutic effect of non-arthroscopic Specific positioning/reduction device-assisted double Endobutton in the treatment of distal clavicular fractures and acromioclavicular dislocations.Methods A retrospective study and analysis of 38 patients with distal clavicular fractures and acromioclavicular joint dislocations were treated using minimally invasive small incision non-arthroscopic specific positioning/reduction devices from January 2020 to July 2023.Among them were 26 males and 12 females,with an average age of(45.34±14.67)years.The average postoperative follow-up duration was(22.18±17.91)months.Acromioclavicular joint dislocations were observed in 33 cases(4 of Rockwood type III and 29 of Rockwood type V).In comparison,distal clavicular fractures were found in 5 cases,all of which were Neer type V.A comparative analysis was conducted between the affected and unaffected shoulder joints regarding Constant score,UCLA score,VAS pain score at pre-treatment,and one week,one month,three months,six months,and one-year post-treatment.Additionally,the occurrence of complications in the affected shoulder was also evaluated.Results The patient experienced a significant reduction in symptoms within one month after surgery.Statistical significance(P<0.05)was observed in the differences in VAS pain scores between the affected side at one-week post-surgery compared to pre-surgery and at one-month post-surgery compared to one-week post-surgery.Postoperative functional scores showed a notable improvement,leading to immediate good stability.Statistical significance(P<0.05)was found in the differences of Constant scores for the affected side at one-week post-surgery compared to pre-surgery,at one-month post-surgery compared to one-week post-surgery,at three months post-surgery compared to one-month post-surgery-and at six months post-surgery compared to 3 months post-surgery.Similarly,the differences in UCLA scores for the affected side at one-week post-surgery compared to pre-surgery,at one-month post-surgery compared to one-week post-surgery,and at three months post-surgery compared to one-month post-surgery were statistically significant(P<0.05).Constant and UCLA scores for the affected side compared to the unaffected side showed statistically significant differences before and during post-treatment follow-ups(P<0.05).Conclusions Using a non-arthroscopic coracoclavicular ligament reconstruction-specific positioning/reduction device in conjunction with strut plate suspension fixation offers a method for treating distal clavicular fractures and acromioclavicular joint dislocations.This approach enables rapid and accurate fixation and swift recovery,minimizes complications,has a short learning curve,and facilitates widespread adoption.