三重Endobutton钢板技术与双Endobutton钢板技术治疗Tossy Ⅲ型肩锁关节脱位疗效比较
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摘要
目的比较三重无袢Endobutton钢板联合Orthcord线技术与双重Endobutton带袢钢板技术治疗TossyⅢ型肩锁关节脱位疗效。方法回顾分析2015年8月-2016年10月收治TossyⅢ型肩锁关节脱位46例,按治疗方式分为三重Endobutton钢板组(24例)和双重Endobutton组(22例),对两组手术时间、并发症、Constant评分、疗效、肩关节复位情况进行对比分析。结果三重Endobutton组和双重Endobutton组手术时间及并发症方面无差异,术后12个月,两组疼痛、日常活动、肩关节活动度、Constant评分总分分别为(14.45±1.63,12.54±1.56)、(18.52±2.76,15.72±2.51)(37.83±6.59,34.02±6.02)、(94.51±9.36,86.87±8.92),差异有统计学意义(P<0.05),两组在肌力方面(23.86±5.28,34.02±6.02)差异无统计学意义(P>0.05),以肩锁关节脱位评分系统评定疗效:三重Endobutton组:优19例,良5例,差0例,优良率为100.00%;双重Endobutton组:优11例,良7例,差4例,优良率为81.82%,差异有统计学意义(P<0.05);放射学方面:三重Endobutton组复位肩锁关节无脱位情况发生,双重Endobutton组共发生4例脱位。结论治疗TossyⅢ型肩锁关节脱位,三重无袢Endobutton钢板联合Orthcord线技术较双重Endobutton带袢钢板技术能更好的改善肩关节疼痛,肩关节功能恢复更佳,从目前已完成病例的临床观察结果来看是治疗肩锁关节脱位的理想方法。
Objective To compare the efficacy of Tossy Ⅲ acromioclavicular joint dislocation treated by triple non-deaf Endobutton plate combined with Orthcord line technology and double Endobutton band splint plate technology. Methods Analysing a total of 46 cases of Tossy Ⅲ acromioclavicular joint dislocation which were treated retrospectively from August 2015 to October2016. They were divided into triple Endobutton plate group(24 cases) and dual Endobutton group(22 cases) according to treatment mode. Clinical datas of two groups' operative time,complications,constant score,curative effect,shoulder joint reduction.Results There is no difference in operative time and complications between the triple Endobutton group and the dual Endobutton group. After 12 months of operation,the total scores of pain,daily activities,shoulder motion,and constant scores were respectively(14.45±1.63,12.54±1.56),(18.52±2.76,15.72±2.51)(37.83±6.59,34.02±6.02),(94.51±9.36,86.87±8.92),and the difference was statistically significant(P<0.05),and the two groups were in muscle strength(23.86±5.28),34.02±6.02),the difference is no statistical significant(P>0.05). The efficacy was evaluated by acromioclavicular joint dislocation scoring system. Triple Endobutton group :excellent in 19 cases,good in 5 cases,poor in 0 cases,excellent rate was 100.00%;double Endobutton Group:excellent in 11 cases,good in 7 cases,poor in 4 cases,excellent rate was 81.82%,the difference was statistically significant(P <0.05);radiology:no case of dislocation occurred in triple Endobutton group,a total of 4 cases of dislocation occurred in double Endobutton group.Conclusion The treatment of Tossy Ⅲ acromioclavicular joint dislocation,triple non-deaf Endobutton plate combined with Orthcord line technology can better improve shoulder pain and double the recovery of shoulder joint function compared with double Endobutton band splint plate technology. Judging from the clinical observation results of the currently completed cases,it is an ideal method to treat acromioclavicular joint dislocation.
Objective To compare the efficacy of Tossy Ⅲ acromioclavicular joint dislocation treated by triple non-deaf Endobutton plate combined with Orthcord line technology and double Endobutton band splint plate technology. Methods Analysing a total of 46 cases of Tossy Ⅲ acromioclavicular joint dislocation which were treated retrospectively from August 2015 to October2016. They were divided into triple Endobutton plate group(24 cases) and dual Endobutton group(22 cases) according to treatment mode. Clinical datas of two groups' operative time,complications,constant score,curative effect,shoulder joint reduction.Results There is no difference in operative time and complications between the triple Endobutton group and the dual Endobutton group. After 12 months of operation,the total scores of pain,daily activities,shoulder motion,and constant scores were respectively(14.45±1.63,12.54±1.56),(18.52±2.76,15.72±2.51)(37.83±6.59,34.02±6.02),(94.51±9.36,86.87±8.92),and the difference was statistically significant(P<0.05),and the two groups were in muscle strength(23.86±5.28),34.02±6.02),the difference is no statistical significant(P>0.05). The efficacy was evaluated by acromioclavicular joint dislocation scoring system. Triple Endobutton group :excellent in 19 cases,good in 5 cases,poor in 0 cases,excellent rate was 100.00%;double Endobutton Group:excellent in 11 cases,good in 7 cases,poor in 4 cases,excellent rate was 81.82%,the difference was statistically significant(P <0.05);radiology:no case of dislocation occurred in triple Endobutton group,a total of 4 cases of dislocation occurred in double Endobutton group.Conclusion The treatment of Tossy Ⅲ acromioclavicular joint dislocation,triple non-deaf Endobutton plate combined with Orthcord line technology can better improve shoulder pain and double the recovery of shoulder joint function compared with double Endobutton band splint plate technology. Judging from the clinical observation results of the currently completed cases,it is an ideal method to treat acromioclavicular joint dislocation.
引文
[1]王国文,廖卫华,董谢平.半腱肌肌腱移植重建喙锁韧带加钩钢板固定治疗肩锁关节Ⅲ度脱位的临床应用[J].江西医药,2011,46(10):905-906.
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[4]胡敏,唐浩然,刘庆,等.Endobutton带袢钢板内固定治疗RockwoodⅢ型肩锁关节脱位[J].中国骨与关节损伤杂志,2010,25(10):900-901.
[5]罗国强,乐海浪.锁骨钩钢板临床应用探讨[J].江西医药,2013,48(11):993-995.
[6]朱建炜,刘璠,张建华,等.三重固定纽扣钢板解剖重建陈旧性Ⅲ度肩锁关节脱位[J].中国修复重建外科杂志,2012,26(2):201-204.
[7]田竞,于海龙,薛海鹏,等.Endobutton技术治疗肩锁关节脱位失效的原因分析[J].中国骨与关节外科,2012,5(6):497-500.
[8]颜瑞健,陆建伟,张春.改良双Endobutton技术治疗TossyⅢ型肩锁关节脱位的远期疗效分析[J].中国骨伤,2014,27(1):9-12.
[9]黄超,林木良,祁伟,等.三重带袢纽扣钢板与锁骨钩钢板治疗急性肩锁关节脱位的远期疗效[J].中国矫形外科杂志,2016,24(24):2256-2259.
[10]蒋栋,吕书军,洪晔,等.锁骨钩钢板与三Endobutton钢板治疗新鲜肩锁关节脱位疗效比较[J].中国修复重建外科杂志,2012,26(9):1025-1028.
[11]王中海,王月,成兵,等.三Endobutton钢板微创治疗肩锁关节脱位的临床研究[J].河北医药,2014,36(3):409-411.
[12]Spencer EE Jr.Treatment of grade Ⅲ acromioclavicular joint injuries:a systematic review[J].Clin orthop Relat Res,2007,455(1):38-44.
[13]吕书军,曹勇,周广鍳,等.三重固定纽扣钢板肩锁关节复位的生物力学[J].中国组织工程研究与临床康复,2011,15(9):1675-1679.
[14]许福生,李桓毅,刘方刚,等.三重带袢纽扣钢板与锁骨钩钢板治疗急性肩锁关节脱位的疗效比较[J].中国矫形外科杂志,2012,20(8):700-703.
[15]诸力,杨贺杰,赵万军,等.Endobutton袢钢板和锁骨钩钢板治疗新鲜肩锁关节脱位的病例对照研究[J].中国骨伤,2012,25(2)2:120-123.
[2]蒋协远,王大伟.骨科临床疗效评价标准[M].人民卫生出版社.2005.73.
[3]周志林,周许辉.韧带转移张力带内固定治疗重度肩锁关节脱位[J].江西医药,2001,36(6):409-411.
[4]胡敏,唐浩然,刘庆,等.Endobutton带袢钢板内固定治疗RockwoodⅢ型肩锁关节脱位[J].中国骨与关节损伤杂志,2010,25(10):900-901.
[5]罗国强,乐海浪.锁骨钩钢板临床应用探讨[J].江西医药,2013,48(11):993-995.
[6]朱建炜,刘璠,张建华,等.三重固定纽扣钢板解剖重建陈旧性Ⅲ度肩锁关节脱位[J].中国修复重建外科杂志,2012,26(2):201-204.
[7]田竞,于海龙,薛海鹏,等.Endobutton技术治疗肩锁关节脱位失效的原因分析[J].中国骨与关节外科,2012,5(6):497-500.
[8]颜瑞健,陆建伟,张春.改良双Endobutton技术治疗TossyⅢ型肩锁关节脱位的远期疗效分析[J].中国骨伤,2014,27(1):9-12.
[9]黄超,林木良,祁伟,等.三重带袢纽扣钢板与锁骨钩钢板治疗急性肩锁关节脱位的远期疗效[J].中国矫形外科杂志,2016,24(24):2256-2259.
[10]蒋栋,吕书军,洪晔,等.锁骨钩钢板与三Endobutton钢板治疗新鲜肩锁关节脱位疗效比较[J].中国修复重建外科杂志,2012,26(9):1025-1028.
[11]王中海,王月,成兵,等.三Endobutton钢板微创治疗肩锁关节脱位的临床研究[J].河北医药,2014,36(3):409-411.
[12]Spencer EE Jr.Treatment of grade Ⅲ acromioclavicular joint injuries:a systematic review[J].Clin orthop Relat Res,2007,455(1):38-44.
[13]吕书军,曹勇,周广鍳,等.三重固定纽扣钢板肩锁关节复位的生物力学[J].中国组织工程研究与临床康复,2011,15(9):1675-1679.
[14]许福生,李桓毅,刘方刚,等.三重带袢纽扣钢板与锁骨钩钢板治疗急性肩锁关节脱位的疗效比较[J].中国矫形外科杂志,2012,20(8):700-703.
[15]诸力,杨贺杰,赵万军,等.Endobutton袢钢板和锁骨钩钢板治疗新鲜肩锁关节脱位的病例对照研究[J].中国骨伤,2012,25(2)2:120-123.