两种喙锁韧带重建技术治疗Tossyossy Ⅲ型肩锁关节脱位的临床疗效研究  

COMPARISON OF EFFECTIVENESS BETWEEN TWO OPERATIVE TECHNIQUES OF CORACOCLAVICULAR LIGAMENT RECONSTRUCTION FOR TREATMENT OF Tossy TYPE III ACROMIOCLAVICULAR JOINT DISLOCATION

作　　者：汤红伟 高生 殷勇 李云飞 韩擎天 李慧章 

机构地区：[1]上海市嘉定区中心医院骨科上海,201800

出　　处：《中国修复重建外科杂志》2015年第11期1321-1326,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨双Endobutton带袢钢板与带线锚钉结合Endobutton钢板两种喙锁韧带重建技术治疗TossyⅢ型肩锁关节脱位的临床疗效。方法回顾性分析2010年5月-2014年3月收治的TossyⅢ型肩锁关节脱位患者5 6例,分别应用双Endobutton带袢钢板（Endobutton组,31例）与带线锚钉结合Endobutton钢板（锚钉组,25例）进行喙锁韧带重建。两组患者年龄、性别、致伤原因、受伤侧别、合并伤、内科合并症、受伤至手术时间等一般资料比较差异均无统计学意义（P〉0.05）,具有可比性。记录并比较两组患者手术时间、植入物费用、术后并发症、术前及术后患肩Constant-Murley评分及术后Karlsson分级。结果 Endobutton组手术时间明显高于锚钉组（t=4.285,P=0.000）;两组植入物费用比较差异无统计学意义（t=1.555,P=0.126）。两组患者术后切口均Ⅰ期愈合,无感染和皮肤坏死等早期并发症发生。所有患者均获随访,随访时间11-35个月,平均15.6个月。随访期间Endobutton组1例复位部分丢失,6例喙锁间有异位骨化;其余患者无肩锁关节再脱位,内固定物松动、断裂及继发骨折等并发症发生;两组并发症发生情况比较差异有统计学意义（P=0.013）。两组患者术后9个月患肩Constant-Murley评分均较术前显著改善（P〈0.05）,但术前及术后9个月两组间比较差异无统计学意义（P〉0.05）。末次随访时,Karlsson分级两组间比较差异无统计学意义（Z=—0.628,P=0.530）。结论双Endobutton带袢钢板与带线锚钉结合Endobutton钢板两种喙锁韧带重建技术治疗TossyⅢ型肩锁关节脱位均能取得良好临床疗效,但后者操作更简便,手术时间更短,并发症更少。Objective To evaluate and compare the effectiveness of double Endobutton technique and suture anchor combined Endobutton plate in the treatment of Tossy type III acromioclavicular joint dislocation. Methods Between May 2010 and March 2014, a retrospective study was preformed on 56 patients with Tossy type III acromioclavicular joint dislocation. The coracoclavicular ligament was reconstructed with double Endobutton technique in 31 cases（Endobutton group）, and with suture anchor combined Endobutton plate in 25 cases（Anchor group）. There was no significant difference in age, gender, injury causes, injury side, associated injury, medical comorbidities, and disease duration between 2 groups（P〈0.05）. The operation time, medical device expenses, postoperative complications, preoperative and postoperative Constant-Murley scores, and postoperative Karlsson grading of the injured shoulder were compared between 2 groups. Results The average operation time in Endobutton group was significantly greater than that in Anchor group（t=4.285, P=0.000）; there was no significant difference in the medical device expenses between 2 groups（t=1.555, P=0.126）. Primary healing of incision was obtained in all patients of 2 groups; no early complications of infection and skin necrosis occurred. All patients were followed up 15.6 months on average（range, 11-35 months）. During follow-up, some loss of reduction and ectopic ossification in the coracoclavicular gap were observed in 1 caseand 6 cases of Endobutton group, respectively. No recurrence of acromioclavicular joint dislocation, implant fixation loosening and broken, and secondary fractures occurred in the other patients. There was significant difference in the incidence of postoperative complications between 2 groups（P=0.013）. Constant-Murley scores of the injured shoulder significantly increased at 9 months after operation when compared with preoperative values in 2 groups（P〈0.05）, but no significant difference was observed between 2 groups（P〈0.0

关 键 词：肩锁关节脱位 韧带重建 Endobutton带袢钢板 带线锚钉 

分 类 号：R687.3[医药卫生—骨科学]