双Endobutton钢板与锁骨钩钢板内固定治疗Rockwood Ⅲ、Ⅴ型肩锁关节脱位的疗效比较

目的比较双Endobutton钢板与锁骨钩钢板内固定治疗RockwoodⅢ、Ⅴ型肩锁关节脱位的远期疗效。方法回顾性分析自2009-05—2014-06诊治的40例RockwoodⅢ、Ⅴ型肩锁关节脱位,采用双Endobutton钢板内固定治疗12例(双Endobutton钢板组),采用锁骨钩钢板内固定治疗28例(锁骨钩钢板组)。比较2组手术时间、术中出血量、并发症情况,以及末次随访时肩关节疼痛VAS评分、肩关节功能Constant-Murley评分。结果双Endobutton钢板组手术时间较锁骨钩钢板组长,且术中出血量大于锁骨钩钢板组,差异有统计学意义(P0.05)。40例均获得随访24~84个月,平均41.4个月。末次随访时2组肩关节疼痛VAS评分及肩关节功能Constant-Murley评分差异无统计学意义(P0.05)。双Endobutton钢板组术后1例复位丢失,1例异位骨化,3例肩部疼痛;锁骨钩钢板组术后11例肩部疼痛,2例肩关节活动受限,2例肩峰下骨质吸收,未出现复位丢失。结论双Endobutton钢板与锁骨钩钢板内固定治疗RockwoodⅢ、Ⅴ型肩锁关节脱位疗效满意,且双Endobutton钢板内固定对肩关节功能影响小,术后肩痛发生率低,无需取出内固定,但手术技术要求较高。

A comparative study of double Endobutton technique and clavicular hook plate for acute acromioclavicular joint dislocation

Objective To compare the long-term clinical outcomes of double Endobutton technique and clavicular hook plate in the treatment of patients with acute dislocation of the acromioclavicular joint (Rockwood type Ⅲ,Ⅴ).Methods A retrospective evaluation was performed of 40 patients surgically treated for acute Rockwood type Ⅲ,Ⅴ acromioclavicular joint dislocation with double Endobutton (12 patients) fixation or clavicular hook plate (28 patients) from May 2009 to June 2014.The 2 groups were compared in terms of operation duration,intraoperative blood loss,complications of shoulder,and visual analog scale (VAS),Constant score for shoulder at last followed-up.Results The operation duration in the Endobutton group was longer than that in the clavicular hook plate group,the intraoperative blood loss in the Endobutton group was more than that in the clavicular hook plate group,which were statistical difference (P ＜0.05).In the VAS score and Constant score for shoulder at last followed-up (ranged from 24-84 months,with an average of 41.4 months) there were no statistical difference between the 2 groups (P ＞0.05).Three cases of shoulder pain,1 case of dislocation relapse and 1 case of heterotopic ossification were found in the Endobutton group while 11 cases of shoulder pain,2 cases of shoulder activity limits,2 cases of acromion osteolysis and no case of dislocation relapse occurred in the clavicular hook plate group.Conclusion Both double Endobutton technique and clavicular hook plate are effective in the treatment of acute complete dislocation of the acromioclavicular joint,though double Endobutton technique may be more advantageous in functional recovery of the shoulder,few shoulder pain,no removal of internal fixation,however,it needs more skills and experience for the surgeon.