双束袢钢板与锁骨钩治疗急性肩锁脱位比较  

Comparison of double-loop huttons and clavicular hook for acute acromioclavicular dislocation

作　　者：沈国蔚[1] 李冬冬 彭俊洋 杨永江[1] 杨丰真[1] 陈晖[1] 田纪伟[1] 丁志勇 SHEN Guo-wei;LI Dong-dong;PENG Jun-yang;YANG Yong-jiang;YANG Feng-zhen;CHEN Hui;TIAN Ji-wei;DING Zhi-yong(Department of Orthopedics,BenQ Medical Center,The Affiliated BenQ Hospital,Nanjing Medical University,Nanjing 210019,China)

机构地区：[1]南京医科大学附属明基医院骨科,江苏南京210019

出　　处：《中国矫形外科杂志》2024年第16期1474-1479,共6页Orthopedic Journal of China

基　　金：南京市卫生科技发展专项基金项目(编号:YKK21252)。

摘　　要：[目的]比较双束Endobutton带袢钢板与锁骨钩钢板治疗急性肩锁关节脱位的疗效。[方法]回顾性分析2019年1月—2021年6月本院收治的44例Rockwood III型以上的急性肩锁关节脱位患者的临床资料,21例采用双束Endobutton带袢钢板固定(袢板组),23例采用钩钢板固定(钩板组),比较两组围手术期、随访及影像学资料。[结果]两组手术时间、术中失血量及主动活动时间的差异均无统计学意义(P>0.05),但袢板组切口长度[(5.3±0.6)cm vs(6.2±1.1)cm,P=0.002]、住院时间[(8.1±1.6)d vs(9.6±2.8)d,P=0.042]显著优于钩板组。随访时间平均(14.5±3.3)个月,随时间推移,两组VAS评分、ConstantMurley评分、肩关节前屈上举及外展上举ROM均显著改善(P<0.05)。术前两组间上述指标的差异均无统计学意义(P>0.05),术后3个月及末次随访时,袢板组VAS评分[(2.1±0.7)vs(3.4±0.7),P<0.001,(1.0±0.7)vs(2.4±0.8),P<0.001]、ConstantMurley评分[(80.8±3.3)vs(69.4±5.0),P<0.001,(90.0±3.1)vs(80.4±5.8),P<0.001]、肩关节前屈上举ROM[(147.6±7.0)°vs(117.4±8.1)°,P<0.001,(171.9±6.8)°vs(153.0±9.1)°,P<0.001]及外展上举ROM[(140.0±7.7)°vs(99.1±6.7)°,P<0.001,(165.7±5.1)°vs(140.4±8.2)°,P<0.001]均显著优于钩板组。影像学方面,两组患者术后喙锁间距、肩锁间距均显著减小(P<0.05),相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。[结论]双束Endobutton带袢钢板治疗肩锁关节脱位,较锁骨钩钢板固定,具有手术切口更小、肩关节功能更好、并发症发生率更少等优势,且无需二次取出内置物,是治疗急性肩锁关节脱位的良好选择。[Objective] To compare the clinical efficacy of double-loop Endobutton plates and clavicular hook plate for acute acromioclavicular dislocation. [Methods] A retrospective study was conducted on 44 patients who received surgical treatment for Rockwood type III or more severe type acute acromioclavicular dislocation in our hospital from January 2019 to June 2021. Based on surgeon-patient discussion, 21 patients received double-loop button plates fixation(the DLB group), while other 23 patients underwent hook plate fixation(the HP group). Perioperative period, follow-up and imaging data of the two groups were compared. [Results] Although there were no significant differences in operation time, intraoperative blood loss and active activity time between the two groups(P>0.05), the DLB group proved significantly superior to the HP group in terms of incision length [(5.3±0.6) cm vs(6.2±1.1) cm, P=0.002] and hospital stay [(8.1±1.6) days vs(9.6±2.8) days, P=0.042]. As time went on in the follow-up period lasted for(14.5±3.3) months on an average, the VAS and Constant-Murley scores, as well as shoulder forward flexion-uplifting and abduction-uplifting range of motions(ROMs) significantly improved in both groups(P<0.05). There was no statistical significance in the abovesaid items before operation(P>0.05), but the DLB group was significantly better than the HP group 3 months postoperatively and at the last follow-up in terms of VAS score [(2.1±0.7) vs(3.4±0.7), P<0.001;(1.0±0.7) vs(2.4±0.8), P<0.001], Constant-Murley score [(80.8±3.3) vs(69.4±5.0), P<0.001;(90.0±3.1) vs(80.4±5.8.), P<0.001], forward flexion-uplifting ROM [(147.6±7.0)° vs(117.4±8.1)°, P<0.001;(171.9±6.8)° vs(153.0±9.1)°, P<0.001] and abduction-uplifting ROM [(140.0±7.7)° vs(99.1±6.7)°, P<0.001;(165.7±5.1)° vs(140.4±8.2)°, P<0.001]. With respect of imaging, the postoperative coracoclavicular distance and acromioclavicular distance were significantly decreased in both groups compared with those preoperatively(P<0.05), whereas whic

关 键 词：肩锁关节脱位 双束重建 Endobutton带袢钢板 钩钢板 

分 类 号：R683.41[医药卫生—骨科学]