摘要
目的 分析关节镜下细骨道双束Endobutton固定治疗Rockwood Ⅲ～Ⅴ型肩锁关节脱位的临床疗效.方法 回顾性分析2015年2月至2022年2月于温州医科大学附属浙江省台州医院接受关节镜下细骨道双束Endobutton固定的肩锁关节脱位患者34例,男24例、女10例,年龄(50.9±11.0)岁(范围21～74岁).左侧24例、右侧10例.致伤原因:车祸伤23例、摔伤7例、高处坠落伤4例.Rockwood分型:Ⅲ型17例、Ⅳ型9例、Ⅴ型8例.采用疼痛视觉模拟评分(visual ana-logue scale,VAS)、美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分、Constant-Murley评分和关节活动度评价肩关节疼痛及功能改善情况.结果 所有患者均顺利完成手术并获得随访,随访时间(16.6±2.8)个月(范围12～24个月).患者术后VAS评分均降低,与术前比较差异有统计学意义(F=199.408,P＜0.001).末次随访时VAS评分为(1.32±0.47)分,小于术前的(4.71±1.19)分,差异有统计学意义(P＜0.001).患者术后ASES评分均升高,与术前比较差异有统计学意义(F=335.838,P＜0.001).末次随访时ASES评分为(88.85±6.41)分,大于术前的(34.76±5.79)分,差异有统计学意义(P＜0.001).患者术后 3、6个月和末次随访的 Constant-Murley 评分分别为(77.79±5.34)分、(87.40±5.19)分、(88.17±4.40)分,均大于术前的(37.41±6.52)分,差异有统计学意义(P＜0.05).末次随访时肩关节前屈、体侧内旋及体侧外旋分别为172.9°±6.4°、59.2°±6.2°、59.3°±5.9°.患肩术前、术后3个月和末次随访时的喙锁间距分别为(1.76±0.42)mm、(0.84±0.19)mm、(0.87±0.18)mm,手术前后比较差异有统计学意义(F=101.160,P＜0.001);其中术后3个月和末次随访均小于术前,差异有统计学意义(P＜0.05).所有切口均一期愈合,且术后无一例出现血管或神经损伤、内固定感染、喙突或锁骨骨隧道骨折、内固定松动或断裂.结论 关节镜下细骨道双束固定Rockwood Ⅲ～Ⅴ型肩锁关节脱位可改善患者肩关节功能和减轻疼痛,手术安全性高.
Abstract
Objective To analyse the clinical efficacy of arthroscopic double-bundle Endobutton fixation of the thin bone channel in the treatment of Rockwood type Ⅲ-Ⅴ acromioclavicular joint dislocation.Methods A total of 34 patients with acro-mioclavicular joint dislocation,24 males and 10 females,aged 50.9±11.0 years(range,21-74 years),who underwent arthroscopic double-bundle Endobutton fixation of the thin bone channel at Zhejiang Province Taizhou Hospital,Wenzhou Medical University,from February 2015 to February 2022 were retrospectively analyzed.There were 24 cases on the left side and 10 cases on the right side.Causes of injury:23 cases of car accident,7 cases of fall,4 cases of falling from height.Rockwood classification:Type Ⅲ 17 cases,type Ⅳ 9 cases,type Ⅴ 8 cases.The visual analogue scale(VAS),American Shoulder and Elbow Surgeons(ASES)score,Constant-Murley score,and joint range of motion were used to evaluate shoulder pain and functional improvement.Results All patients successfully completed the operation and were followed up for an average of 16.6±2.8 months(range,12-24 months).Post-operative VAS scores were significantly lower compared to preoperative scores(F=199.408,P＜0.001),with the final follow-up VAS score being 1.32±0.47,significantly lower than the preoperative score of 4.71±1.19(P＜0.001).Postoperative ASES scores were significantly higher compared to preoperative scores(F=335.838,P＜0.001),with the final follow-up ASES score being 88.85±6.41,significantly higher than the preoperative score of 34.76±5.79(P＜0.001).The Constant-Murley scores of 3 months,6 months after operation and the last follow-up were 77.79±5.34,87.40±5.19 and 88.17±4.40,respectively,which were higher than that before operation 37.41±6.52,and the difference was statistically significant(P＜0.05).At the final follow-up,shoulder flexion,adduction,and abduction were 172.9°±6.4°,59.2°±6.2°,and 59.3°±5.9°,respectively.The coracoclavicular distance was 1.76±0.42 mm,0.84±0.19 mm,and 0.87±0.18 mm before operation,3 months after operation,and at the last follow-up,respective-ly,and the difference was statistically significant(F=101.160,P＜0.001).Whereas,3 months postoperative and the final follow-up were smaller than the preoperative ones,and the difference was statistically significant(P＜0.05).All incisions healed in one stage,and there was no vascular or nerve injury,internal fixation infection,coracoid process or clavicle bone tunnel fracture,or in-ternal fixation loosening or breakage.Conclusion Arthroscopic double-bundle Endobutton fixation with thin bone channel for the treatment of Rockwood type Ⅲ-Ⅴ acromioclavicular joint dislocation can improve shoulder function and reduce pain,with high surgical safety.
维普
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