纽扣钢板治疗RockwoodⅢ型肩锁关节脱位术后失败病例分析  

Failure cases analysis of endobutton button plate in the treatment of Rockwood type Ⅲ acromioclavicular dislocation

作　　者：刘恒山 寿康全 朱高波[1] LIU Hengshan;SHOU Kangquan;ZHU Gaobo(Department of Emergency and Trauma,Yichang Central People's Hospital,The First College of Clinical Medical Science,China Three Gorges University,Yichang,Hubei,443003,China)

机构地区：[1]三峡大学第一临床医学院,宜昌市中心人民医院急诊与创伤外科,湖北宜昌443003 [2]三峡大学第一临床医学院,宜昌市中心人民医院骨科,湖北宜昌443003

出　　处：《实用手外科杂志》2025年第1期26-29,共4页Journal of Practical Hand Surgery

基　　金：湖北省自然科学基金项目(项目编号:2021CFB488)。

摘　　要：目的分析RockwoodⅢ型肩锁关节脱位(Acromioclavicular joint dislocation,AJD)应用Endo-button纽扣钢板内固定术后失败原因。方法回顾性分析2021年1月-2023年1月宜昌市中心人民医院救治的37例RockwoodⅢ型AJD患者的临床资料。所有患者行Endobutton纽扣钢板内固定手术治疗,术前及术后3、6个月随访时采用Constant-Murley功能评分,随访期间复查X线片观察是否出现内固定失败并记录、分析其原因。结果37例AJD患者均获得6~14个月随访,平均7.5个月。与术前相比,术后3、6个月Constant-Murley评分为(91.05±4.43)分、(93.68±5.75)分,较术前(78.65±8.50)分增高(P<0.05)。术后半年内共发现4例出现术后内固定失败,内固定失效的原因包括:骨隧道建立偏斜1例,手术操作不当1例,过度复位1例,术后过早不当持重锻炼1例。结论Endobutton纽扣钢板内固定治疗RockwoodⅢ型AJD疗效满意,但仍可能发生术后内固定失败。失败的原因主要包括术中操作不当、隧道建立偏斜、过度复位、术后过早不当持重锻炼及严重的骨质疏松等。Objective To analyze of the reasons for failure of Rockwood Ⅲ acromioclavicular joint dislocation(AJD)after internal fixation with Endobutton button plate.Methods A retrospective study was conducted to analyse the clinical data of 37 patients with Rockwood type Ⅲ AJD admitted to Yichang Central People's Hospital from Jan 2021 to Jan 2023.All the patients were treated with open reduction and internal fixation with endobutton button plates.The Constant-Murley score was used to evaluate shoulder joint function before surgery and at 3 and 6 months follow-up.During the follow-up period,X-ray films were reviewed to observe whether internal fixation failure occurred and recorded,and the reasons of internal fixation failure cases were analyzed.Results All the patients were followed up for 6-14 months,the average follow-up time of 37 patients were 7.5 months.Compared with before surgery,the Constant-Murley scores at 3 months and 6 months after surgery were significantly increased[(89.05±7.08)points vs.(56.05±9.08)points]、[(94.05±6.05)points vs.(56.05±9.08)points](P<0.05).During the postoperative follow-up period,a total of 4 patients were found to have postoperative internal fixation failure.The reasons for internal fixation failure included:1 cases of deviated construction of bone tunnel,1 case of improper operation,1 cases of excessive joint reduction and 1 case of earlier load bearing.Conclusion The surgical procedure for treating Rockwood Ⅲ AJD with Endobutton button plate treatment is a satisfactory treatment method.However,it requires careful attention to several details during the operation to minimize the risk of internal fixation failure.The causes of failure may be deviated tunnel construction,excessive joint reduction,improper operation,earlier load bearing exercise after surgery,severe osteoporosis and so on.

关 键 词：肩锁关节 脱位 失败 

分 类 号：R68[医药卫生—骨科学]