Endobutton钢板与改良Weaver-Dunn联合锁骨钩钢板治疗Rookwood Ⅲ型肩锁关节脱位的近期临床疗效观察
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摘要
目的比较Endobutton钢板与改良Weaver-Dunn联合锁骨钩钢板治疗Rookwood Ⅲ型肩锁关节脱位的近期临床疗效。方法回顾性分析我院骨科2016年1月至2017年6月分别采用Endobutton钢板与改良Weaver-Dunn联合锁骨钩钢板治疗的54例Rookwood Ⅲ型肩锁关节脱位病人的资料,根据治疗方法不同分为Endobutton组(30例)和Weaver-Dunn组(24例),对两组手术时间、术中出血量、住院时间、恢复工作时间进行对比;分别采用肩关节Constant-Murley评分、疼痛视觉模拟量表(visual analogue scale, VAS)评分比较两组术前、术后3个月、术后6个月、术后1年的肩关节功能恢复及疼痛改善情况。结果两组术后均未出现内固定断裂、切口感染及血管损伤,术后总并发症比较差异无统计学意义(χ~2=1.752,P=0.237);Endobutton组的手术时间、术中出血量、住院时间、恢复工作时间均低于Weaver-Dunn组,差异均有统计学意义(P均<0.05);Endobutton组和Weaver-Dunn组术后3个月、术后6个月、术后1年Constant-Murley各项评分:疼痛、日常活动、患手最大位置、力量测试、肩外展、肩前屈、肩外旋、肩内旋及VAS评分与术前比较,差异均有统计学意义(P均<0.05);术后3个月、术后6个月及术后1年,Endobutton组Constant-Murley各项评分及VAS评分均优于Weaver-Dunn组,差异均有统计学意义(P均<0.05)。结论 Endobutton钢板和改良Weaver-Dunn联合锁骨钩钢板均能恢复RookwoodⅢ型肩锁关节脱位病人的肩关节功能,但前者近期临床疗效更具有优势。
Objective To compare the short-term clinical efficacy of Endobutton method and modified Weaver-Dunn combined with clavicular hook plate in the treatment of Rookwood type Ⅲ acromioclavicular joint dislocation. Methods A retrospective analysis was performed on 54 patients with Rokwood type Ⅲacromioclavicular dislocation treated with Endobutton plate reconstruction and modified Weaver-Dunn method in Department of Orthopaedics of our hospital, and the patients were divided into Endobutton group(30 cases)and Weaver-Dunn group(24 cases) according to different treatment methods. The perioperative parameters including operation time, intraoperative blood loss, hospital stay and recovery time were compared between the two groups. The shoulder joint Constant-Murley and visual analogue scale(VAS) scores were used to compare the functional recovery and pain improvement of the shoulder joint before and 3 rd month, 6 th month and 1 st year after operation. Results All 54 patients were followed up, none of the two groups presented internal fixation fracture, incision infection and vascular injury after surgery, and the difference in total postoperative complications was not statistically significant(χ~2=1.752, P=0.237). The operation time, intraoperative blood loss, hospitalization time and recovery time was significantly reduced in the Endobutton group as compared with those in the Weaver-Dunn group(P<0.05). As compared with preoperation, the difference in the Endobutton group and Weaver-Dunn group was statistically significant at 3 rd month, 6 th month and 1 st year after operation in Constant-Murley scores, such as pain, daily activities, maximum position of the affected hand, strength test,shoulder abduction, shoulder forward flexion, shoulder out-turn, shoulder inturn and VAS scores(P<0.05). The Constant-Murley scores and VAS scores in the Endobutton group were better than those in the Weaver-Dunn group at 3 rd month, 6 th month and 1 st year postoperatively(all P<0.05). Conclusion Both the Endobutton method and the modified Weaver-Dunn combined with clavicular hook plate can restore the shoulder function of patients with Rookwood Ⅲ acromioclavicular joint dislocation, but the former has a more clinical advantage.
Objective To compare the short-term clinical efficacy of Endobutton method and modified Weaver-Dunn combined with clavicular hook plate in the treatment of Rookwood type Ⅲ acromioclavicular joint dislocation. Methods A retrospective analysis was performed on 54 patients with Rokwood type Ⅲacromioclavicular dislocation treated with Endobutton plate reconstruction and modified Weaver-Dunn method in Department of Orthopaedics of our hospital, and the patients were divided into Endobutton group(30 cases)and Weaver-Dunn group(24 cases) according to different treatment methods. The perioperative parameters including operation time, intraoperative blood loss, hospital stay and recovery time were compared between the two groups. The shoulder joint Constant-Murley and visual analogue scale(VAS) scores were used to compare the functional recovery and pain improvement of the shoulder joint before and 3 rd month, 6 th month and 1 st year after operation. Results All 54 patients were followed up, none of the two groups presented internal fixation fracture, incision infection and vascular injury after surgery, and the difference in total postoperative complications was not statistically significant(χ~2=1.752, P=0.237). The operation time, intraoperative blood loss, hospitalization time and recovery time was significantly reduced in the Endobutton group as compared with those in the Weaver-Dunn group(P<0.05). As compared with preoperation, the difference in the Endobutton group and Weaver-Dunn group was statistically significant at 3 rd month, 6 th month and 1 st year after operation in Constant-Murley scores, such as pain, daily activities, maximum position of the affected hand, strength test,shoulder abduction, shoulder forward flexion, shoulder out-turn, shoulder inturn and VAS scores(P<0.05). The Constant-Murley scores and VAS scores in the Endobutton group were better than those in the Weaver-Dunn group at 3 rd month, 6 th month and 1 st year postoperatively(all P<0.05). Conclusion Both the Endobutton method and the modified Weaver-Dunn combined with clavicular hook plate can restore the shoulder function of patients with Rookwood Ⅲ acromioclavicular joint dislocation, but the former has a more clinical advantage.
引文
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[2]Sirin E,Aydin N,Mert Topkar O.Acromioclavicular joint injuries:diagnosis,classification and ligamentoplasty procedures[J].EFORT Open Rev,2018,3(7):426-433.
[3]Williams GR,Nguyen VD,Rockwood Jr CA.Classification and radiographic analysis of acromioclavicular dislocations[J].Appl Radiol,1989,18(2):29-34.
[4]沙卫平,严飞,陈国兆.Triple-Endobutton钢板治疗RockwoodⅢ型及以上肩锁关节脱位[J].骨科,2017,8(4):268-272.
[5]Bradley JP,Elkousy H.Decision making:operative versus nonoperative treatment of acromioclavicular joint injuries[J].Clin Sports Med,2003,22(2):277-290.
[6]Spencer EE Jr.Treatment of gradeⅢacromioclavicular joint injuries:a systematic review[J].Clin Orthop Relat Res,2007,455:38-44.
[7]Abat F,Gich I,Natera L,et al.Clinical factors that affect perceived quality of life in arthroscopic reconstruction for acromioclavicular joint dislocation[J].Rev Esp Cir Ortop Traumatol,2018,62(2):121-126.
[8]郑鸿,何冰,谭宏昌,等.改良与经典双纽扣钢板技术治疗肩锁关节脱位的临床疗效比较[J/CD].中华关节外科杂志(电子版),2018,12(2):158-162
[9]宋鑫,阿布都萨拉木·阿布都克力木,丁慧勇,等.肩锁关节脱位3种内固定术后并发肩锁关节骨性关节炎的临床研究[J].中国骨与关节损伤杂志,2018,33(3):259-262.
[10]Constant CR,Murley AH.A clinical method of functional assessment of the shoulder[J].Clin Orthop Relat Res,1987,214:160-164.
[11]Tauber M.Management of acute acromioclavicular joint dislocations:current concepts[J].Arch Orthop Trauma Surg,2013,133(7):985-995.
[12]潘昭勋,杜德凯,张洪鑫,等.三种Endobutton术式重建喙锁韧带术后稳定性的生物力学对比研究[J].中国临床解剖学杂志,2017,35(1):74-77.
[13]王凯,车彪,刘俊,等.锁骨钩钢板治疗新鲜NeerⅡ型锁骨远端骨折及TossyⅢ型肩锁关节脱位[J].骨科,2010,1(3):122-124,127.
[14]宋升,孙振中,印飞,等.钩钢板结合自体肌腱重建喙锁韧带与单纯钩钢板固定治疗肩锁关节脱位的比较[J].中国组织工程研究,2018,22(15):2355-2360.
[15]于洋,孙建华.喙肩韧带移位联合锁骨钩钢板治疗8例RockwoodⅢ型肩锁关节脱位[J].中国矫形外科杂志,2016,24(22):2110-2112.
[16]单志军,蔡卫华,江志俊.带袢钢板与锁骨钩钢板治疗肩锁关节脱位的比较研究[J].南京医科大学学报(自然科学版),2017,37(12):1601-1604.
[17]徐刚,李小飞,邱旭升,等.纽扣钢板技术与锁骨钩钢板治疗急性肩锁关节脱位的疗效比较[J].重庆医学,2018,47(7):979-981.
[18]王万宏,杜远立,熊家伟,等.线缆套绕喙突与锁骨固定治疗肩锁关节脱位的临床观察[J].骨科,2017,8(1):30-33,43.
[19]Xue C,Song LJ,Zhang H,et al.Truly anatomic coracoclavicular ligament reconstruction with 2 endobutton devices for acute Rockwood typeⅤacromioclavicular joint dislocations[J].J Shoulder Elbow Surg,2018,27(6):e196-e202.
[20]Teodoro RL,Nishimi AY,Pascarelli L,et al.Surgical treatment of acromioclavicular dislocation using the endobutton[J].Acta Ortop Bras,2017,25(3):81-84.
[21]孙华,罗轶,毛汉兴,等.锁骨钩钢板与带绊纽扣钢板治疗TossyⅢ型肩锁关节脱位的疗效研究[J].骨科,2011,2(1):44-46.
[2]Sirin E,Aydin N,Mert Topkar O.Acromioclavicular joint injuries:diagnosis,classification and ligamentoplasty procedures[J].EFORT Open Rev,2018,3(7):426-433.
[3]Williams GR,Nguyen VD,Rockwood Jr CA.Classification and radiographic analysis of acromioclavicular dislocations[J].Appl Radiol,1989,18(2):29-34.
[4]沙卫平,严飞,陈国兆.Triple-Endobutton钢板治疗RockwoodⅢ型及以上肩锁关节脱位[J].骨科,2017,8(4):268-272.
[5]Bradley JP,Elkousy H.Decision making:operative versus nonoperative treatment of acromioclavicular joint injuries[J].Clin Sports Med,2003,22(2):277-290.
[6]Spencer EE Jr.Treatment of gradeⅢacromioclavicular joint injuries:a systematic review[J].Clin Orthop Relat Res,2007,455:38-44.
[7]Abat F,Gich I,Natera L,et al.Clinical factors that affect perceived quality of life in arthroscopic reconstruction for acromioclavicular joint dislocation[J].Rev Esp Cir Ortop Traumatol,2018,62(2):121-126.
[8]郑鸿,何冰,谭宏昌,等.改良与经典双纽扣钢板技术治疗肩锁关节脱位的临床疗效比较[J/CD].中华关节外科杂志(电子版),2018,12(2):158-162
[9]宋鑫,阿布都萨拉木·阿布都克力木,丁慧勇,等.肩锁关节脱位3种内固定术后并发肩锁关节骨性关节炎的临床研究[J].中国骨与关节损伤杂志,2018,33(3):259-262.
[10]Constant CR,Murley AH.A clinical method of functional assessment of the shoulder[J].Clin Orthop Relat Res,1987,214:160-164.
[11]Tauber M.Management of acute acromioclavicular joint dislocations:current concepts[J].Arch Orthop Trauma Surg,2013,133(7):985-995.
[12]潘昭勋,杜德凯,张洪鑫,等.三种Endobutton术式重建喙锁韧带术后稳定性的生物力学对比研究[J].中国临床解剖学杂志,2017,35(1):74-77.
[13]王凯,车彪,刘俊,等.锁骨钩钢板治疗新鲜NeerⅡ型锁骨远端骨折及TossyⅢ型肩锁关节脱位[J].骨科,2010,1(3):122-124,127.
[14]宋升,孙振中,印飞,等.钩钢板结合自体肌腱重建喙锁韧带与单纯钩钢板固定治疗肩锁关节脱位的比较[J].中国组织工程研究,2018,22(15):2355-2360.
[15]于洋,孙建华.喙肩韧带移位联合锁骨钩钢板治疗8例RockwoodⅢ型肩锁关节脱位[J].中国矫形外科杂志,2016,24(22):2110-2112.
[16]单志军,蔡卫华,江志俊.带袢钢板与锁骨钩钢板治疗肩锁关节脱位的比较研究[J].南京医科大学学报(自然科学版),2017,37(12):1601-1604.
[17]徐刚,李小飞,邱旭升,等.纽扣钢板技术与锁骨钩钢板治疗急性肩锁关节脱位的疗效比较[J].重庆医学,2018,47(7):979-981.
[18]王万宏,杜远立,熊家伟,等.线缆套绕喙突与锁骨固定治疗肩锁关节脱位的临床观察[J].骨科,2017,8(1):30-33,43.
[19]Xue C,Song LJ,Zhang H,et al.Truly anatomic coracoclavicular ligament reconstruction with 2 endobutton devices for acute Rockwood typeⅤacromioclavicular joint dislocations[J].J Shoulder Elbow Surg,2018,27(6):e196-e202.
[20]Teodoro RL,Nishimi AY,Pascarelli L,et al.Surgical treatment of acromioclavicular dislocation using the endobutton[J].Acta Ortop Bras,2017,25(3):81-84.
[21]孙华,罗轶,毛汉兴,等.锁骨钩钢板与带绊纽扣钢板治疗TossyⅢ型肩锁关节脱位的疗效研究[J].骨科,2011,2(1):44-46.