摘要
目的探讨关节镜下双Endobutton钮扣钢板内固定治疗急性肩锁关节脱位的临床疗效。方法采用回顾性病例系列研究分析2015年5月-2018年2月佛山市中医院收治的32例RockwoodⅢ型或Ⅴ型急性肩锁关节脱位患者临床资料,其中男26例,女6例;年龄22~56岁[(37.7±1.6)岁]。Rockwood分型:Ⅲ型22例,Ⅴ型10例。受伤至手术时间2~5d。均采用关节镜下双Endobutton钮扣钢板内固定行喙锁韧带重建术。记录手术时间、住院时间、术后肩关节制动时间。采用视觉模拟评分(VAS)、Constant-Murley肩关节功能评分(CMS)、美国肩肘外科医师(ASES)评分、加州大学洛杉矶分校(UCLA)评分及肩关节简明测试(SST)评分对术前及末次随访时肩关节功能进行评估。同时观察有无感染、松动、关节再脱位等并发症情况。结果患者均获随访8~48个月[(27.8±11.6)个月]。手术时间为48~93min[(65.0±24.6)min],住院时间为3.2~10d[(6.5±2.6)d],术后制动时间为21~35.3d[(28.2±7.1)d]。患者手术切口均为甲级愈合。VAS由术前(5.7±2.5)分降至末次随访时(1.2±0.8)分(P<0.01),CMS由术前(29.3±3.4)分上升至末次随访时(93.2±2.1)分(P<0.05),ASES评分由术前(28.9±10.1)分上升至末次随访时(95.7±5.6)分(P<0.05),UCLA评分由术前(11.6±2.8)分上升至末次随访时(34.2±1.5)分(P<0.05),SST评分由术前(3.5±1.2)分上升至末次随访时(9.7±1.4)分(P<0.01)。术中及术后并发症发生率为16%(5/32),其中2例术中喙突隧道向一侧豁出,术中改为"U"形环绕喙突法固定;1例术后发现复位不足,二次手术肩锁关节成形后复位;1例锁骨端钮扣钢板下陷导致复位丢失;1例过度复位。结论对于RockwoodⅢ型或Ⅴ型急性肩锁关节脱位患者,关节镜下双Endobutton钮扣钢板内固定重建喙锁韧带,具有手术时间短、术后疼痛减轻、关节功能恢复满意等优势。但该方法术中及术后并发症发生率也较高,应严格掌握适应证。
Objective To investigate the clinical efficacy of arthroscopic double Endobutton plate internal fixation in the treatment of acute acromioclavicular joint dislocation. Methods A retrospective case series study was performed to analyze the clinical data of 32 patients with Rockwood type III or V acute acromioclavicular joint dislocation admitted to Foshan Hospital of TCM from May 2015 to February 2018. There were 26 males and six females, aged 22-56 years [(37.7±1.6)years]. There were 22 patients with Rockwood type III and 10 patients with type V. The duration from injury to operation was 2-5 days. All patients were treated with arthroscopic double Endobutton plate internal fixation for coracoclavicular ligament reconstruction. The operation time, hospitalization time, and postoperative shoulder joint braking time were recorded. The shoulder joint function was evaluated by the Constant-Murley score (CMS), visual analogue scale (VAS), American shoulder and elbow surgeons (ASES) score, University of California Los Angeles (UCLA) score and simple shoulder test (SST) before operation and at the last follow-up. Meanwhile, complications such as infection, loosening and joint dislocation were recorded. Results All patients were followed up for 8-48 months [(27.8±11.6)months]. The operation time was 48-93 minutes[(65.0±24.6)minutes], the hospitalization time was 3.2-10 days [(6.5±2.6)days], and the postoperative braking time was 21-35.3 days[(28.2±7.1)days]. All patients had a grade A healing of surgical incision. The VAS was decreased from preoperative (5.7±2.5)points to (1.2±0.8)points at the last follow-up (P<0.01);CMS wasvincreased from preoperative (29.3±3.4)points to (93.2±2.1)points at the last follow-up (P<0.05);ASES score was increased from preoperative (28.9±10.1)points to (95.7±5.6)points at the last follow-up (P<0.05);UCLA score was improved from preoperative (11.6±2.8)points to (34.2±1.5)points at the last follow-up (P<0.05);SST score was improved from preoperative (3.5±1.2)points to (9.7±1.4)points at the last follow-up (P<0.01). The incidence of intraoperative and postoperative complications was 16% (5/32). In two patients, the surgery was changed to U shape fixation circulating the coracoid base due to the coracoidbone tunnel cutting out. One patient was found to have insufficient reduction and received the acromioclavicular joint operation. One patient had reduction loss due to the clavicle button collapsing, and one patient had excessive reduction. Conclusions For Rockwood type III or V acute acromioclavicular dislocation patients, arthroscopic double Endobutton plates for coracoclavicular ligament reconstruction has the advantages of less intraoperative trauma, quick recovery and satisfactory clinical result. However, the incidence of intraoperative and postoperative complications is relatively high, and indications should be strictly controlled.
作者
赵立连
卢明峰
许挺
邢基斯
何利雷
Zhao Lilian;Lu Mingfeng;Xu Ting;Xing Jisi;He Lilei(Department of Orthopedic Sports Medicine,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2019年第1期71-78,共8页
Chinese Journal of Trauma
作者简介
通信作者:赵立连,Email:zhaolilian@163.com.
