双Endobutton技术与锁骨钩钢板治疗TossyⅢ型肩锁关节脱位的疗效比较  

A comparative study of short-term outcomes of Tossy grade Ⅲ acromioclavicular separation between double Endobutton technique and clavicular hook plate

作　　者：汪李军[1] 杨惠林[2] 史源欣[1] 邵伟忠[1] 梁吉华[1] 陆永兴[1] 袁振庭[1] 苏振刚[1] 佘远时[2] 

机构地区：[1]江苏省常熟市第二人民医院创伤骨科,215500 [2]苏州大学第一附属医院骨科

出　　处：《中华创伤骨科杂志》2013年第4期283-287,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较双Endobutton技术与锁骨钩钢板（CHP）治疗TossyⅢ型肩锁关节脱位的近期疗效．方法回顾性分析2009年3月至2011年12月收治的59例TossyⅢ型肩锁并节脱位患者资料，男41例，女18例；年龄21～69岁，平均44．0岁；左侧21例，右侧38例。按治疗方式不同分为双Endobutton组（26例）和CHP组（33例）。两组患者术前一般资料比较差异均无统计学意义（P〉0．05），具有可比性。术后随访观察并比较两组患者患肩疼痛视觉模拟评分（VAS）、外展上举及前屈上举活动度、Constant-Murley坪分及Karlsson分级。结果所有患者术后获11～30个月（平均15．2个川）随访。术后9个月双Endobutton组与CHP组患者患肩VAS评分平均分别为（2．1±0．7）、（2．9±0．8）分；双Endobutton组患肩外展上举和前屈上举活动度平均分别为100．8°±13．2°、131．5°±13．3°，CHP组分别为81．3°±8．3°、96．6°±10．8°，两组患者以上观察指标比较差异均有统计学意义（P〈0．05）；双Endobutton和CHP组Constant-Murley评分平均分别为（85．3±6．3）、（82．4±6．1）分，Karlsson分级优良率分别为84．6％（22／26）、90．9％（30／33），两组患者以上指标比较差异均无统计学意义（P〉0．05）。结论舣Endobutton技术与CHP治疗TossyⅢ型肩锁关市脱位的疗效相当，但前者较后者更明显地改善患者早期肩关节疼痛、肩关节外展上举和前屈上举活动范围。Objective To compare short-term outcomes of double Endobutton technique versus clavicular hook plale （CLIP） in the treatment of Tossy gradeⅢacromioclavicular separation.Methods A cohort of 59 patients with Tossy gradeⅢacromioclavicular dislocation were treated between March 2009 and December 2011 in our department.They were 41 men and 18 women, aged from 21 to 69 years （average,44. 0 years）.Twenty-one left shoulders and 38 right ones were affected. Twenty-six patients were treated with double Endobutton technique （group A）and 33 with CHP （group B）. The 2 groups were similar in general clinical data （ P 〉 0. 05）.They were compared in terms of postoperative visual analogue scale （VAS） scores,abduction-rise, flexion-rise,Constant-Murley scores and Karlsson grading for functional recovery of the injured shoulder.Results The mean follow-up time was 15.2 months （from 11 to 30 months） . At 9 months post-surgery,the average VAS score was 2. 1 ± 0. 7 point for group A and 2.9 ±0. 8 points for group B, the abduction-rise and flexion-rise averaged 100.8°±13.2°and 131.5°± 13.3°for group A and 81.3°±8.3°and 96.6°± 10. 8° for group B,There were significant differences between the 2 groups in the above indexes （P 〈 0.05）, but not in the average Constant-Murley scores （85.3 ±6.3 versus 82.4 ±6. 1 points） or Karlsson grading of excellent to good cases （84.6% versus 90.9 %） （P〉 0.05） .Conclusions In management of gradeⅢ acromioclavicular separation,compared with CHP, double Endobutton technique can result in similar functional outcomes but a greater range of motion and less shoulder pain at the early post-surgery stage.

关 键 词：肩锁关节 肩脱位 韧带  关节 内固定器 

分 类 号：R687.3[医药卫生—骨科学]