切换至 "中华医学电子期刊资源库"

中华卫生应急电子杂志 ›› 2016, Vol. 02 ›› Issue (01) : 21 -25. doi: 10.3877/cma.j.issn.2095-9133.2016.01.007

所属专题: 文献

论著

锁骨钩钢板内固定与Endobutton带袢钢板喙锁韧带重建治疗急性不稳定肩锁关节脱位的疗效对比
刘志元1,(), 朱建国1, 杨雷1   
  1. 1. 213000 常州市武进人民医院南院骨科
  • 收稿日期:2016-01-25 出版日期:2016-02-18
  • 通信作者: 刘志元

Comparison of hook plate fixation and ligament reconstruction in treatment of acute unstable acromioclavicular joint dislocation

Zhiyuan Liu1,(), Jianguo Zhu1, Lei Yang1   

  1. 1. Department of Orthopedics, Changzhou Wunjin People’s Hospital, Changzhou 213000, China
  • Received:2016-01-25 Published:2016-02-18
  • Corresponding author: Zhiyuan Liu
  • About author:
    Corresponding author: Liu Zhiyuan, Email:
引用本文:

刘志元, 朱建国, 杨雷. 锁骨钩钢板内固定与Endobutton带袢钢板喙锁韧带重建治疗急性不稳定肩锁关节脱位的疗效对比[J]. 中华卫生应急电子杂志, 2016, 02(01): 21-25.

Zhiyuan Liu, Jianguo Zhu, Lei Yang. Comparison of hook plate fixation and ligament reconstruction in treatment of acute unstable acromioclavicular joint dislocation[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2016, 02(01): 21-25.

目的

比较锁骨钩钢板内固定和Endobutton带袢钢板重建喙锁韧带两种方法治疗急性不稳定性肩锁关节脱位的临床疗效以及放射学影像差异。

方法

将江苏大学附属武进医院收治的50例接受手术的急性不稳定性肩锁关节脱位患者分为锁骨钩钢板组(A组,20例)和喙锁韧带重建组(B组,30例)。采用CMS评分,VAS评分以及喙突锁骨间距(coracoclaviculardistance,CCD)来观察和比较两组之间的差异。

结果

A组CMS评分为(94.4±6.97)分,B组为(95.87±3.50)分。A组VAS评分为(0.85±0.93)分,B组为(0.87±0.82)分。放射影像学:肩锁关节在两组中均得到满意复位,手术前后CCD:A组为术前(15.91±5.29) mm,术后(6.94±2.90) mm,间距改善率为(263.00±181.45)% ;B组为术前(15.10±6.43) mm,术后(5.54±2.10)mm,间距改善率为(293.67±116.39)%。间距的改善A组与B组无明显差异(P>0.05)。并发症:A组和B组均发生肩锁关节半脱位,但A组发生率(15%)低于B组(26.7%)。但A组存在很高的肩峰下骨溶解(80%)以及较高的肩锁关节骨关节炎发生率(25%),喙锁韧带骨化的发生率(35%)同样明显高于B组(13.3%)。

结论

锁骨钩钢板内固定和喙锁韧带重建治疗急性不稳定性肩锁关节脱位均能够取得较满意的临床疗效。锁骨钩钢板长期放置会引起较多的并发症,建议尽早去除。肩锁关节半脱位是喙锁韧带重建常见的主要并发症。

Objective

To compare clinical and radiographic outcomes of hook plate fixation and coracoclavicular ligament reconstruction in the treatment of acute unstable acromioclavicular joint dislocation.

Methods

Fiftypatients with acute unstable dislocation of the acromioclavicular joint were enrolled in the study and divided into two groups according to the treatment modality, ie, internal fixation with a hook plate group (Group I, 20 cases) and coracoclavicular ligament reconstruction group (Group II, 30 cases). The clinical outcomes were evaluated using Constant- Murley score (CMS) and visual analog scale (VAS) and the radiographic outcomes assessed based on coracoclaviculardistance (CCD).

Results

The mean CMS score was(94.4±6.97) points and (95.87±3.50) points in Groups I and II, respectively, with no statistical difference. The mean VAS scores at the final follow-up was (0.85±0.93) points and (0.87±0.82) points in Groups I and II, respectively, with no statistical difference. The acromioclavicular joints were well reduced in both groups. CCDwas improved from preoperative (15.91±5.29)mm to postoperative (6.94±2.90)mm in Group I, with an improvement of (263.00±181.45)%, and from preoperative (15.10±6.43)mm to postoperative (5.54±2.10)mm in Group II, with an improvement of (293.67±116.39)%. The improvement in Group I was not significantly superior to that in Group II(P>0.05) Subluxation was observed in both groups, with higher incidence in Group II(26.7%) than that in Group I(15%). However, erosions of the acromion undersurface and osteoarthritis of acromioclavicular were only observed in group I, with an incurrence of 80% and 25%, respectively. Furthermore, coracoclavicular ligament ossification shown more frequently in group I (35%) than group II (13.3%).

Conclusions

For acute unstable acromioclavicular joint dislocation, hook plate fixation and coracoclavicular ligament reconstruction can attain comparable satisfactory clinical and radiographicoutcomes. Hook plate should be moved earlier to avoid the complication. Subluxation is the major complication of ligament reconstruction.

表1 锁骨钩钢板组和喙锁韧带重建组患者基本资料比较
表2 锁骨钩钢板组和喙锁韧带重建组患者术后临床疗效比较(±s)
表3 锁骨钩钢板组和喙锁韧带重建组患者放射影像学比较(mm,±s)
1
Oussedik S. Injuries to the clavicle and acromioclavicular joint[J]. Br J Hosp Med, Lond, 2007, 68(4): 68-70.
2
Willimon SC, Gaskill TR, Millett PJ. Acromioclavicular joint injuries: anatomy, diagnosis, and treatment[J]. Phys Sportsmed, 2011, 39(1): 116-122.
3
Phillips AM, Smart C, Groom AF. Acromioclavicular dislocation: conservative or surgical therapy[J]. Clin Orthop Relat Res, 1998, (353): 10-17.
4
Johansen JA, Grutter PW, McFarland EG, et al. Acromioclavicular joint injuries: indications for treatment and treatment options[J]. J Shoulder Elbow Surg, 2011, 20(2 Suppl): 70-82.
5
Balke M, Schneider MM, Akoto R, et al. Acute acromioclavicular joint injuries: Changes in diagnosis and therapy over the last 10 years[J]. Unfallchirurg, 2015, 118(10): 851-857.
6
Virtanen KJ, Remes VM, Tulikoura IT, et al. Surgical treatment of Rockwood grade-V acromioclavicular joint dislocations 50 patients followed for 15–22 years[J]. Acta Orthop, 2013, 84(2): 191-195.
7
Leidel BA, Braunstein V, Kirchhoff C, et al. Consistency of long-term outcome of acute Rockwood grade III acromioclavicular joint separations after K-wire transfixation[J]. J Trauma, 2009, 66(6): 1666-1671.
8
Flinkkilä T, Ristiniemi J, Lakovaara M, et al. Hook-plate fixation of unstable lateral clavicle fractures: a report on 63 patients[J]. Acta Orthop, 2006, 77(4): 644-649.
9
Jafary D, Keihan Shokouh H, Najd Mazhar F, et al. Clinical and Radiological Results of Fixation of Acromioclavicular Joint Dislocation by Hook Plates Retained for More Than Five Months[J]. Trauma Mon, 2014, 19(2): 13728.
10
von Heideken J, Boström Windhamre H, Une-Larsson V, et al. Acute surgical treatment of acromioclavicular dislocation type V with a hook plate: superiority to late reconstruction[J]. J Shoulder Elbow Surg, 2013, 22(1): 9-17.
11
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): 2564-2570.
12
Kienast B, Thietje R, Queitsch C, et al. Mid-term results after operative treatment of Rockwood grade III-V acromioclavicular joint dislocation with an ac-hook-plate[J]. Eur J Med Res, 2011, 16(2): 52-56.
13
Chiang CL, Yang SW, Tsai MY, et al. Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: a case report[J]. J Shoulder Elbow Surg, 2010, 19(4): 13-15.
14
Gille J, Heinrichs G, Unger A, et al.Arthroscopic-assisted hook plate fixation for acromioclavicular joint dislocation[J]. Int Orthop, 2013, 37(1): 77–82.
15
Jeon IH, Dewnany G, Hartley R, et al.Chronic acromioclavicular separation: the medium term results of coracoclavicular ligament reconstruction using braided polyester prosthetic ligament[J]. Injury, 2007, 38(11): 1247-1253.
16
Giannotti S, Dell’osso G, Bugelli G, et al. Surgical treatment of acromioclavicular dislocation with LARS artificial ligament[J]. Eur J Orthop Surg Traumatol, 2013, 23(8): 873-876.
17
Struhl, Steven MD. Double endobutton technique for repair of complete acromioclavicular joint dislocations[J]. Tech in Shoulder Elbow Surg, 2007, 8(4): 175-179.
18
Wei HF, Chen YF, Zeng BF, et al. Triple endobuttton technique for the treatment of acute complete acromioclavicular joint dislocations: preliminary results [J]. Int Orthop, 2011, 35(4): 555–559.
19
Kraus N, Haas NP, Scheibel M, et al. Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations in a coracoclavicular Double-TightRope technique: V-shaped versus parallel drill hole orientation[J]. Arch Orthop Trauma Surg, 2013, 133(10): 1431-1440.
20
Pan Z, Zhang H, Sun C, et al. Arthroscopy-assisted reconstruction of coracoclavicular ligament by Endobutton ?xation for treatment of acromioclavicular joint dislocation [J]. Arch Orthop Trauma Surg, 2015, 135(1): 9-16.
[1] 池宸申, 林彬辉, 丁浩亮, 孙卫兵, 孙健. 关节镜下双束重建喙锁韧带治疗肩锁关节脱位[J]. 中华腔镜外科杂志(电子版), 2021, 14(02): 97-103.
[2] 崔壮, 魏宽海, 陈滨, 胡岩君, 余斌. Rockwood III型肩锁关节脱位治疗策略[J]. 中华肩肘外科电子杂志, 2023, 11(03): 279-283.
[3] 刘有才, 张义君, 赵欣磊, 周家玄. Endobutton带袢钛板与钩钢板治疗肩锁关节脱位病例的疗效比较[J]. 中华肩肘外科电子杂志, 2023, 11(03): 212-217.
[4] 潘超, 张博, 韩磊, 刘俊阳, 崔鹏, 闫兵山, 田旭, 刘林涛, 东靖明. 肩锁关节脱位治疗的研究进展[J]. 中华肩肘外科电子杂志, 2023, 11(02): 186-191.
[5] 张涛, 崔进, 周启荣, 陈晓, 苏佳灿. 肩锁关节脱位的治疗进展[J]. 中华肩肘外科电子杂志, 2023, 11(01): 77-82.
[6] 郁凯. 陈旧性肩锁关节脱位的治疗[J]. 中华肩肘外科电子杂志, 2023, 11(01): 7-11.
[7] 王雄, 杨璐, 子树明, 魏文强, 梁志民, 顾峥嵘, 曹烈虎. TightRope钢板与锁骨钩钢板治疗Rockwood III型急性肩锁关节脱位的疗效比较分析[J]. 中华肩肘外科电子杂志, 2022, 10(04): 300-306.
[8] 何国文, 高大伟, 陈亮, 胡栢均. 保守治疗与锁骨钩钢板内固定手术治疗Rockwood Ⅲ型肩锁关节脱位的中长期疗效对比研究[J]. 中华肩肘外科电子杂志, 2022, 10(02): 110-114.
[9] 何国文, 高大伟, 陈亮, 胡栢均, 吴宇峰. Endobutton带袢钢板内固定与锁骨钩钢板内固定治疗RockwoodⅢ型肩锁关节脱位的中长期疗效观察[J]. 中华肩肘外科电子杂志, 2022, 10(02): 105-109.
[10] 贾建波, 易诚青, 何家文, 敖荣广, 张旭. 锁骨钩钢板内固定术后钢板钩与肩峰匹配性影像学研究[J]. 中华肩肘外科电子杂志, 2022, 10(01): 49-54.
[11] 张亚军, 党育, 杨剑, 张刘会, 谭利, 杨忠, 郁凯. 关节镜下喙锁和肩锁韧带重建治疗陈旧性Rockwood III型肩锁关节脱位[J]. 中华肩肘外科电子杂志, 2022, 10(01): 28-33.
[12] 刘中帆, 曾浩, 裴泳榕, 王靖, 翁晓军. 关节镜下细骨道双Endobutton钢板联合Fiberwire缝线治疗Rockwood III ~ V型肩锁关节脱位[J]. 中华肩肘外科电子杂志, 2021, 09(02): 142-147.
[13] 钟浩博, 刘伟乐, 刘正蕊, 郑少伟, 黄守镔, 孙江森, 孙春汉, 李胜发. 三重带袢钢板技术治疗新鲜Rockwood Ⅲ型肩锁关节脱位手术创伤与临床疗效相关性研究[J]. 中华肩肘外科电子杂志, 2020, 08(04): 327-334.
[14] 敖荣广, 菅振, 贾建波, 李承, 李得见, 张旭, 周建华, 禹宝庆. 锁骨中段骨折合并同侧肩锁关节脱位:诊断要点分析研究[J]. 中华肩肘外科电子杂志, 2020, 08(04): 321-326.
[15] 丰瑞兵, 王华松, 姜壮, 蔡贤华. 锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位[J]. 中华肩肘外科电子杂志, 2020, 08(03): 215-219.
阅读次数
全文


摘要