镜下钮扣钢板锚钉与开放钩钢板治疗肩锁关节脱位

[目的]比较肩关节镜下钮扣钢板(Endobutton)结合锚钉与钩钢板治疗急性肩锁关节脱位的临床疗效。[方法]回顾性分析2014年08月~2018年06月本院收治的63例急性不稳定肩锁关节脱位的患者,按手术方式不同分组,其中34例采用肩关节镜下改良钮扣钢板结合锚钉内固定(关节镜组),29例采用钩钢板内固定(钩钢板组)。[结果]两组患者手术均顺利完成,无血管、神经损伤。关节镜组与钩钢板组在手术时间、术中出血量的差异无统计学意义(P>0.05)。63例随访12~24个月,平均(15.39±3.26)个月。关节镜组未发生晚期并发症,而钩钢板组术后出现肩峰下溶解6例、肩峰下撞击3例、钩钢板取出后再脱位1例,两组间并发症发生率的差异有统计学意义(P<0.05)。随术后时间推移,两组患者Constant评分均显著增加(P<0.05),术后1、3、6、12个月,关节镜组的Constant评分明显优于钩钢板组(P<0.05)。影像方面,两组术后喙锁间距、肩锁间距均较术前显著减少(P<0.05);相同时间点两组间喙锁间距和肩锁间距的差异均无统计学意义(P>0.05)。[结论]关节镜下改良钮扣钢板结合锚钉内固定治疗肩锁关节脱位的临床效果优于钩钢板固定。

Arthroscopic Endobutton plate combined with anchor versus open hook plate for acromioclavicular dislocation

[Objective]To compare the clinical outcomes of arthroscopic Endobutton plate combined with anchor versus open hook plate for acromioclavicular dislocation.[Method]A retrospective study was conducted on 63 patients who underwent surgical treatment for acute acromioclavicular dislocation in our hospital from August 2014 to June 2018.In term of surgical procedures performed,29 patients received arthroscopic Endobutton plate combined with anchor for reconstruction of coracoclavicular ligament(the arthroscopic group),while the remaining 34 patients had acromioclavicular reduction and fixation performed with hook plate fixation(the hook plate group).[Result]The patients in both groups had operation performed smoothly without intraoperative complications,such as neurovascular injuries.There were no significant differences between the two group in operation time and intraoperative blood loss(P>0.05).During the follow-up period ranged from 12 to 24 months with a mean of(15.39±3.26)months,no remarkable late complications were found in anyone of the arthroscopic group,whereas subacromial osteolysis in 6,subacromial impingement in 3,and re-dislocation after implant removed were noted in the hook plate group,which was of statistical significance(P<0.05).The Constant score significantly increased in both groups over time(P<0.05).However,the arthroscopic group had significantly higher Constant score than the hook plate group at 1,3,6 and 12 months postoperatively(P<0.05).In respect to radiographic measurement,the coracoclavicular and acromioclavicular distances significantly decreased after operation in both groups compared with those before operation(P<0.05),whereas they were not significantly different between the two groups at any matching time point(P>0.05).[Conclusion]This arthroscopic reconstruction of coracoclavicular ligament with Endobutton plate combined with anchor does achieve superior clinical outcomes to the conventional open reduction and internal fixation with hook plate for acromioclavicular dislocation.