双Endobutton带袢钢板和锁骨钩钢板治疗肩锁关节脱位的中期疗效比较
|
摘要
目的:比较双Endobutton带袢钢板和锁骨钩钢板治疗肩锁关节脱位的疗效和安全性。方法:纳入2011年6月至2015年2月入院的46例行手术治疗的RockwoodⅢ～Ⅴ型肩锁关节脱位患者,完成随访37例(锁骨钩钢板治疗18例、双Endobutton袢钢板治疗19例),随访3年。对随访患者采用Constant-Murley评分和UCLA肩关节评分标准进行肩关节功能评定,记录中期并发症,并拍摄双肩关节X线片进行影像学评估。结果:术后3 d、3月Endobutton组Constant-Murley评分、UCLA评分较钩钢板组明显增高(P <0.05),而术后1年和最后一次随访两种术式的Constant-Murley评分、UCLA评分差异无统计学意义(P> 0.05)。钩钢板组术后有8例患者存在不同程度的肩部疼痛或不适,疼痛发生率较Endobutton组(2例)高(χ2=5.3917,P=0.020),但取出钢板后仅有1例遗留长期疼痛,Endobutton组有2例术后发生长期疼痛;中期随访Endobutton组总的并发症发生率相对较高(31.6%vs 16.7%),但两组比较无统计学意义(χ2=1.1166,P=0.291)。钩钢板组在术后和取钢板前较双Endobutton组喙锁间距窄(P <0.05),但末次随访时两组喙锁间距差异无统计学意义(t=0.4056, P=0.6875)。结论:双Endobutton袢钢板和锁骨钩钢板治疗RockwoodⅢ～Ⅴ型肩锁关节脱位均可获得满意疗效,总的中期并发症发生率相当,但双Endobutton袢钢板术式恢复更快,是一种安全实用的手术方法。
Objective: To evaluate the effect and safety of double endobutton technique for acromioclavicular joint dislocation compared with clavicular hook plate fixation.Methods:A total of 46 patients with Rockwood typeⅢ～Ⅴ acromioclavicular joint dislocation, who underwent a surgery from June 2011 to February 2015 in our hospi-tal, were enrolled. A 36-month follow-up was completed in 37 of these patients, including 18 patients treated withclavicular hook plate fixation and 19 patients treated with double endobutton technique. Constant-Murley andUCLA scores were used to assess the shoulder joint function of patients followed up. Mid-term complications wererecorded. X-ray of both shoulder joints was used for imaging evaluation. Results: At 3 days and 3 months after sur-gery, the endobutton group had significantly higher Constant-Murley and UCLA scores than the hook plate group(P < 0.05). However, there were no significant differences in Constant-Murley and UCLA scores between the endo-button group and the hook plate group at 1 year postoperatively and the last follow-up(P > 0.05). The hook plategroup had a significantly higher incidence of shoulder pain or discomfort after surgery than the endobutton group(8 cases vs 2 cases, χ2= 5.3917, P = 0.020), but the pain disappeared in most patients after the plates were removed.The incidence of total midterm complications was higher in the endobutton group than in the hook plate group(31.6% vs 16.7%, χ2= 1.1166, P = 0.291). The coracoclavicular distance was significantly shorter in the hook plategroup than in the endobutton group after surgery and before plate removal(P < 0.05), but was not significantly different between the two groups at the last follow-up(t = 0.4056, P = 0.6875). Conclusion: Both double endobuttontechnique and clavicular hook plate fixation have a satisfactory effect in the treatment of Rockwood type Ⅲ ～ Ⅴ acromioclavicular joint dislocation, with comparable incidence of total midterm complications. However, double endo-button technique is a safe, useful way to treat acromioclavicular joint dislocation as the patients treated with thistechnique have faster recovery postoperatively.
Objective: To evaluate the effect and safety of double endobutton technique for acromioclavicular joint dislocation compared with clavicular hook plate fixation.Methods:A total of 46 patients with Rockwood typeⅢ～Ⅴ acromioclavicular joint dislocation, who underwent a surgery from June 2011 to February 2015 in our hospi-tal, were enrolled. A 36-month follow-up was completed in 37 of these patients, including 18 patients treated withclavicular hook plate fixation and 19 patients treated with double endobutton technique. Constant-Murley andUCLA scores were used to assess the shoulder joint function of patients followed up. Mid-term complications wererecorded. X-ray of both shoulder joints was used for imaging evaluation. Results: At 3 days and 3 months after sur-gery, the endobutton group had significantly higher Constant-Murley and UCLA scores than the hook plate group(P < 0.05). However, there were no significant differences in Constant-Murley and UCLA scores between the endo-button group and the hook plate group at 1 year postoperatively and the last follow-up(P > 0.05). The hook plategroup had a significantly higher incidence of shoulder pain or discomfort after surgery than the endobutton group(8 cases vs 2 cases, χ2= 5.3917, P = 0.020), but the pain disappeared in most patients after the plates were removed.The incidence of total midterm complications was higher in the endobutton group than in the hook plate group(31.6% vs 16.7%, χ2= 1.1166, P = 0.291). The coracoclavicular distance was significantly shorter in the hook plategroup than in the endobutton group after surgery and before plate removal(P < 0.05), but was not significantly different between the two groups at the last follow-up(t = 0.4056, P = 0.6875). Conclusion: Both double endobuttontechnique and clavicular hook plate fixation have a satisfactory effect in the treatment of Rockwood type Ⅲ ～ Ⅴ acromioclavicular joint dislocation, with comparable incidence of total midterm complications. However, double endo-button technique is a safe, useful way to treat acromioclavicular joint dislocation as the patients treated with thistechnique have faster recovery postoperatively.
引文
1. Struhl S. Double endobutton technique for repair of complete acromioclavicular joint dislocations[J]. Techniques in Shoulder and Elbow Surgery, 2007, 8(4):175-179.
2 . Struhl S, Wolfson TS. Continuous loop double endobutton reconstruction for acromioclavicular joint dislocation[J]. American Journal of Sports Medicine, 2015, 43(10):2437-2 444.
3 .宋鑫,买买提沙吾提阿吉·买买提,伊力哈木·托合提,等. Endobutton钢板与锁骨钩钢板治疗肩锁关节脱位优良率及并发症的Meta分析[J].中国组织工程研究,2018, 22(3):478-485.
4 .冯永增,洪建军,陈鸿亮,等.锁骨钩钢板与双Endobutton钢板治疗肩锁关节脱位的对比研究[J].中华骨科杂志, 2009, 29(11):1 009-1 014.
5 . Constant CR, Murley AH. A clinical method of functional assessment of the shoulder[J]. Clin Orthop Relat Res,1987, 214:160-164.
6 . Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing Reconstruction[J]. J Bone Joint Surg Am, 1986, 68(8):1 136-1 144.
7 . Müller D, Reinig Y, Hoffmann R, et al. Return to sport after acute acromioclavicular stabilization:a randomized control of double-suture-button system versus clavicular hook plate compared to uninjured shoulder sport athletes[J]. Knee Surg Sports Traumatol Arthrosc, 2018. doi:10 .1007/s00167-018-5044-x.
8 . Kumar N, Sharma V. Hook plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction:a functional outcome study in military personnel[J]. Strategies Trauma Limb Reconstr, 2015,10(2):79-85.
9 . Von Heideken J, Bostr?m Windhamre H, Une-Larsson V, et al. Acute surgical treatment of acromioclavicular dislocation type V with a hook plate:superiority to late reconstruction[J]. Journal of Shoulder and Elbow Surgery,2013, 22(1):9-17.
10 . Kienast B, Thietje R, Queitsch C, et al. Mid-term results after operative treatment of rockwood grade III-V acromioclavicular joint dislocations with an AC-hook-plate[J]. Eur J Med Res, 2011, 16(2):52-56.
11 . Koukakis A, Manouras A, Apostolou CD, et al. Results using the AO hook plate for dislocations of the acromioclavicular joint[J]. Expert Rev Med Devices, 2008, 5(5):567-572.
12 . Steinbacher G, Sallent A, Seijas R, et al. Clavicular hook plate for grade-III acromioclavicular dislocation[J]. J Orthop Surg(Hong Kong), 2014, 22(3):329-332.
13 . Arirachakaran A, Boonard M, Piyapittayanun P, et al.Post-operative outcomes and complications of suspensory loop fixation device versus hook plate in acute unstable acromioclavicular joint dislocation:a systematic review and meta-analysis[J]. J Orthop Traumatol, 2017, 18(4):293-304.
14 . Chen CH, Dong QR, Zhou RK, et al. Effects of hook plate on shoulder function after treatment of acromioclavicular joint dislocation[J]. Int J Clin Exp Med, 2014, 7(9):2 564-2 570.
15 . Eschler A, Gradl G, Gierer P, et al. Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation,however presents with a high rate of acromial osteolysis[J]. Arch Orthop Trauma Surg, 2012, 132(1):33-39.
16 . Chiang CL, Yang SW, Tsai MY, et al. Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation:a case report[J]. Journal of Shoulder and Elbow Surgery, 2010, 19(4):13-15.
17 . Nadarajah R, Mahaluxmivala J, Amin A, et al. Clavicular hook-plate:complications of retaining the implant[J]. Injury, 2005, 36(5):681-683.
18 . Chen CY, Yang SW, Lin KY, et al. A simple technique of suture loop for acute acromioclavicular joint dislocation[J]. Injury, 2013, 44(11):1 662-1 663.
19 . El Shewy MT, El Azizi H. Suture repair using loop technique in cases of acute complete acromioclavicular joint dislocation[J]. J Orthop Traumatol, 2011, 12(1):29-35.
20 .张磊,祁冀,周鑫,等.一种改良双Endobutton袢钢板技术治疗RockwoodⅢ型肩锁关节脱位[J].医学研究生学报, 2017, 30(10):1 079-1 083.
21 .孙琦,吴根发,陈超,等.双endobutton钢板微创内固定治疗rockwoodⅲ-ⅴ型肩锁关节脱位的疗效分析[J].中国骨与关节损伤杂志, 2016, 31(09):977-978.
22 . Grantham C, Heckmann N, Wang L, et al. A biomechanical assessment of a novel double endobutton technique versus a coracoid cerclage sling for acromioclavicular and coracoclavicular injuries[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(6):1 918-1 924.
23 . Athar MS, Ashwood N, Arealis G, et al. Acromioclavicular joint disruptions:A comparison of two surgical approaches'hook'and'rope'[J]. J Orthop Surg(Hong Kong), 2018, 26(1):2309499017749984.
2 . Struhl S, Wolfson TS. Continuous loop double endobutton reconstruction for acromioclavicular joint dislocation[J]. American Journal of Sports Medicine, 2015, 43(10):2437-2 444.
3 .宋鑫,买买提沙吾提阿吉·买买提,伊力哈木·托合提,等. Endobutton钢板与锁骨钩钢板治疗肩锁关节脱位优良率及并发症的Meta分析[J].中国组织工程研究,2018, 22(3):478-485.
4 .冯永增,洪建军,陈鸿亮,等.锁骨钩钢板与双Endobutton钢板治疗肩锁关节脱位的对比研究[J].中华骨科杂志, 2009, 29(11):1 009-1 014.
5 . Constant CR, Murley AH. A clinical method of functional assessment of the shoulder[J]. Clin Orthop Relat Res,1987, 214:160-164.
6 . Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing Reconstruction[J]. J Bone Joint Surg Am, 1986, 68(8):1 136-1 144.
7 . Müller D, Reinig Y, Hoffmann R, et al. Return to sport after acute acromioclavicular stabilization:a randomized control of double-suture-button system versus clavicular hook plate compared to uninjured shoulder sport athletes[J]. Knee Surg Sports Traumatol Arthrosc, 2018. doi:10 .1007/s00167-018-5044-x.
8 . Kumar N, Sharma V. Hook plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction:a functional outcome study in military personnel[J]. Strategies Trauma Limb Reconstr, 2015,10(2):79-85.
9 . Von Heideken J, Bostr?m Windhamre H, Une-Larsson V, et al. Acute surgical treatment of acromioclavicular dislocation type V with a hook plate:superiority to late reconstruction[J]. Journal of Shoulder and Elbow Surgery,2013, 22(1):9-17.
10 . Kienast B, Thietje R, Queitsch C, et al. Mid-term results after operative treatment of rockwood grade III-V acromioclavicular joint dislocations with an AC-hook-plate[J]. Eur J Med Res, 2011, 16(2):52-56.
11 . Koukakis A, Manouras A, Apostolou CD, et al. Results using the AO hook plate for dislocations of the acromioclavicular joint[J]. Expert Rev Med Devices, 2008, 5(5):567-572.
12 . Steinbacher G, Sallent A, Seijas R, et al. Clavicular hook plate for grade-III acromioclavicular dislocation[J]. J Orthop Surg(Hong Kong), 2014, 22(3):329-332.
13 . Arirachakaran A, Boonard M, Piyapittayanun P, et al.Post-operative outcomes and complications of suspensory loop fixation device versus hook plate in acute unstable acromioclavicular joint dislocation:a systematic review and meta-analysis[J]. J Orthop Traumatol, 2017, 18(4):293-304.
14 . Chen CH, Dong QR, Zhou RK, et al. Effects of hook plate on shoulder function after treatment of acromioclavicular joint dislocation[J]. Int J Clin Exp Med, 2014, 7(9):2 564-2 570.
15 . Eschler A, Gradl G, Gierer P, et al. Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation,however presents with a high rate of acromial osteolysis[J]. Arch Orthop Trauma Surg, 2012, 132(1):33-39.
16 . Chiang CL, Yang SW, Tsai MY, et al. Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation:a case report[J]. Journal of Shoulder and Elbow Surgery, 2010, 19(4):13-15.
17 . Nadarajah R, Mahaluxmivala J, Amin A, et al. Clavicular hook-plate:complications of retaining the implant[J]. Injury, 2005, 36(5):681-683.
18 . Chen CY, Yang SW, Lin KY, et al. A simple technique of suture loop for acute acromioclavicular joint dislocation[J]. Injury, 2013, 44(11):1 662-1 663.
19 . El Shewy MT, El Azizi H. Suture repair using loop technique in cases of acute complete acromioclavicular joint dislocation[J]. J Orthop Traumatol, 2011, 12(1):29-35.
20 .张磊,祁冀,周鑫,等.一种改良双Endobutton袢钢板技术治疗RockwoodⅢ型肩锁关节脱位[J].医学研究生学报, 2017, 30(10):1 079-1 083.
21 .孙琦,吴根发,陈超,等.双endobutton钢板微创内固定治疗rockwoodⅲ-ⅴ型肩锁关节脱位的疗效分析[J].中国骨与关节损伤杂志, 2016, 31(09):977-978.
22 . Grantham C, Heckmann N, Wang L, et al. A biomechanical assessment of a novel double endobutton technique versus a coracoid cerclage sling for acromioclavicular and coracoclavicular injuries[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(6):1 918-1 924.
23 . Athar MS, Ashwood N, Arealis G, et al. Acromioclavicular joint disruptions:A comparison of two surgical approaches'hook'and'rope'[J]. J Orthop Surg(Hong Kong), 2018, 26(1):2309499017749984.