Endobutton技术治疗RockwoodⅢ型肩锁关节脱位的生物力学研究  

Biomechanical study of Endobutton technique in treatment of Rockwood type Ⅲ acromioclavicular joint dislocation

作　　者：邓乐章[1] 许勇[1] 周容华 邵泽豹[1] DENG Lezhang,XU Yong, ZHOU Ronghua, et al.(Department of Orthopedics, Xiantao First People＇s Hospital ,Xiantao 433000, Chin)

机构地区：[1]湖北省仙桃市第一人民医院骨科,433000

出　　处：《临床外科杂志》2018年第4期300-303,共4页Journal of Clinical Surgery

摘　　要：目的探讨Endobutton技术重建喙锁韧带治疗RockwoodⅢ型肩锁关节脱位的疗效及生物力学原理。方法住院RockwoodⅢ型肩锁关节脱位病人35例,所有病人均采用Endobutton技术重建喙锁韧带。于治疗前和治疗后1个月、3个月、6个月评价VAS疼痛评分和肩关节功能Constant评分。通过X线片比较治疗后1个月和治疗后6个月喙锁间距离,观察复位丢失情况,并将锁骨表面Endobutton钢板中点到锁骨内缘的长度和整根锁骨的长度比值作为力臂,对复位丢失和固定装置力臂进行相关性分析。结果 35例病人术后获得6~15个月随访,平均8.6个月。治疗前和治疗后1个月、3个月、6个月VAS疼痛评分分别为(6.4±0.5)分、(3.3±0.6)分、(1.3±0.4)、(0.9±0.2)分;Constant评分分别为(26.4±8.5)分、(59.3±7.6)分、(80.4±6.3)、(92.2±3.7)分。术后1个月和术后6个月X线片显示,肩锁关节和喙锁关节之间的距离正常,复位良好。术后1个月测量喙锁关节间距为(27.4±3.1)mm,术后6个月测量喙锁关节间距为(29.3±2.9)mm,平均丢失(1.1±0.8)mm,平均力臂为(0.74±0.03),复位丢失与固定装置之间存在相关性(r=0.54,P<0.05)。结论采用Endobutto技术重建喙锁韧带治疗RockwoodⅢ型肩锁关节脱位能够取得较为满意的临床效果,其术后复位丢失与固定装置安防位置存在相关性,随着力臂的缩短,复位丢失增加,固定装置比较合适的力臂为0.75。Objective To study the effect of reconstruvting coracoclavicular ligament by Endobutton technique on Rockwood type Ⅲ acromioclavicular joint dislocation and the biomechanical analysis. Methods 35 patients with Rockwood type Ⅲ acromioclavicular joint dislocation were treated with Endobutton technique. Visual analog scale（ VAS） and Constant score were evaluated at pre-operation and 1 month,3 and 6 months post-operation. The reduction loss was assessed by evaluating the distance of coracoid and clavicle at 1 month and 6 months post-operation,respectively. Meanwhile,the length from the endobutton midpoint to the proximal end of clavicle（ L1） and the whole length of clavicle（ L） were measured,and the ratio of L1/L as the moment arm of the fixator was calculated to analyse the correlation between reduction loss and moment arm. Results All the patients were followed up with a mean duration of 8. 6 months（ range,6 - 15 months）. All the patients received good reduction after operation at 6 months and the distance between coracoid and clavicle showed good recovery. At pre-operation,and 1 month,3 and 6 months post-operation,the VAS scores were [（ 6. 4 ± 0. 5）,（ 3. 3 ± 0. 6）,（ 1. 3 ± 0. 4）,and（ 0. 9 ±0. 2） ],and the Constant scores were [（ 26. 4 ± 8. 5）,（ 59. 3 ± 7. 6）,（ 80. 4 ± 6. 3）,and（ 92. 2 ± 3. 7） ].The average distance between the coracoid and clavicle at 1 month and 6 months post-operation was（ 27. 4 ± 3. 1） mm and（ 29. 3 ± 2. 9） mm,respectively. The average reduction loss was（ 1. 1 ± 0. 8） mm and the average moment arm was 0. 74 ± 0. 03 at 6 months. There was a significant correlation between the reduction loss and moment arm（ r = 0. 54 P 〉 0. 05）. Conclusion The treatment of Rockwood type Ⅲacromioclavicular joint dislocation with Endobutton technique can obtain satisfactory effect. The placement of the endobutton is closely related to the reduction loss. The shorter moment arm,the greater reduction loss would be. The proper moment a

关 键 词：Endobutton技术 喙锁韧带 肩锁关节脱位 生物力学 

分 类 号：R687.4[医药卫生—骨科学]