双Endobutton带袢钢板治疗Ⅲ型肩锁关节脱位

目的 探讨双Endobutton钢板治疗新鲜Ⅲ型肩锁关节脱位的临床疗效.方法 选取2010年7月至2012年3月期间采用双Endobutton钢板治疗的新鲜Rockwood分型Ⅲ型肩锁关节脱位病例9例,应用Constant-Murley评分系统评估术后肩关节功能,并拍摄X线片.结果 术后随访5～14个月,术后Constant-Murley评分为(92.6±3.8)分,X线显示无脱位.结论 双Endobutton钢板治疗新鲜Ⅲ型肩锁关节脱位近期疗效满意,创伤小,功能恢复快,但远期疗效有待长期随访.     

The Tight-Rope Technique versus Clavicular Hook Plate for Treatment of Acute Acromioclavicular Joint Dislocation: A Systematic Review and Meta-Analysis

Abstract

Objective: The efficacy of the tight-rope (TR) technique and clavicular hook plate (CHP) for the treatment of acute acromioclavicular (AC) joint dislocation is controversial. This meta-analysis aimed to evaluate which method is more appropriate for the treatment of acute AC joint dislocation. Methods: We systematically searched the PubMed, EMBASE, Scopus, ISI Web of Science, Chinese VIP Database, and Chinese Wan-Fang databases from inception to January 2018 using the search term “acromioclavicular joint dislocation AND hook plate.” All prospective and retrospective controlled trials that had compared functional scores, pain scores, reduction loss rates, coracoclavicular (CC) distances, and complications between TR and CHP for acute AC joint dislocation were identified. A total of 13 of 587 studies with 732 patients were included. TR was preferential to CHP for AC joint dislocation given its higher Constant–Murley score, lower Visual Analog Scale pain score, and comparable reduction loss rate and CC distance. Subgroup analyses of the surgical type of TR did not affect the outcome. Results: The TR technique appears to be associated with better functional recovery and less pain than CHP. In addition, it does not increase the risk of reduction loss, CC distance, or operation time. It is also not associated with other complications except the implant migration, and does not require removal of the internal fixation. Conclusions: Thus, our results indicated that for AC joint dislocation, the TR technique may be preferential.     

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

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。     

Endobutton钢板与皮质骨螺钉治疗伴踝关节骨折的急性下胫腓联合损伤的比较

目的 比较两种内固定方法治疗伴踝关节骨折的急性下胫腓联合损伤疗效.方法 回顾性分析66例伴踝关节骨折的急性下胫腓联合损伤的病例.其中31例接受Endobutton钢板治疗,35例接受皮质骨螺钉治疗.首先将两种疗法与术前指标作为自变量,治疗结果作为因变量作Logistic回归分析,再分别对两组术中出血量、手术时间、术后负重时间、术后1年下胫腓联合间隙(TBCS)、术后1年胫腓重叠影(TBOL)、AOFAS评分及并发症行统计学分析.结果 性别为影响治疗结果的独立危险因素,而不同治疗方法与结果并无明显相关性.两组资料术中出血量(t=0.543,P=0.589)、术后1年TBCS(t=0.025,P=0.980)、术后1年TBOL(t=0.711,P=0.480)、AOFAS评分(t=0.577,P=0.566)及术后并发症(χ2=0.020,P=0.888)差异无统计学意义.手术时间(t=2.203,P=0.031)Endobutton钢板组较长,但术后负重时间(t=-18.459,P<0.001)Endobutton钢板组较短,且均差异有统计学意义.结论 Endobutton钢板与皮质骨螺钉治疗伴踝关节骨折的急性下胫腓联合损伤疗效上无明显统计学差异,基本不需二次手术取出,术前应综合考虑,慎重选择内固定.     

回顾性分析Endobutton系统与锁骨钩钢板治疗TossyⅢ型肩锁关节脱位的疗效

目的:回顾性分析Endobutton系统与锁骨钩钢板治疗TossyⅢ型肩锁关节脱位的疗效。方法:31例TossyⅢ型肩锁关节脱位患者,采用切开复位锁骨钩钢板内固定术治疗20例,采用切开复位Endobutton系统内固定术治疗11例,比较两组疗效。结果:按照Karlsson标准评定疗效,锁骨钩钢板组A级18例,B级2例;Endobutton组11例均为A级;两组疗效的差异无统计学意义(P=0.527)。结论:采用切开复位Endobutton系统内固定术治疗TossyⅢ型肩锁关节脱位的疗效和切开复位锁骨钩钢板内固定术一致,值得临床推广。     

内置钮扣钢板重建喙锁韧带治疗TossyⅢ型肩锁关节脱位

目的探讨内置钮扣钢板重建喙锁韧带治疗TossyⅢ型肩锁关节脱位的疗效。方法TossyⅢ型肩锁关节脱位26例,手术采用两块内置钮扣钢板分别置于锁骨上和喙突下方,重建喙锁韧带纠正肩锁关节脱位。采用日本骨科协会(JOA)肩关节疾患治疗判定标准和肩锁关节脱位评分系统对术后疗效进行评价。结果 25例获得6-16个月随访,术后患侧上肢以及肩关节功能得到不同程度的恢复,术前JOA评分为(44.5±3.2)分,末次随访时为(91.4±3.5)分,优良率达92%(23/25)。术后至终末随访时,术后肩锁关节维持复位情况满意,影像学评价的优良率为96%(24/25)。结论内置钮扣钢板重建喙锁韧带治疗新鲜TossyⅢ型肩锁关节脱位疗效满意,肩关节功能以及肩部疼痛改善明显,并发症少。     

双纽扣钢板技术修复肩锁关节完全脱位的临床研究

目的:观察双纽扣钢板技术修复肩锁关节完全脱位的临床疗效。方法:选择改良的肩锁关节损伤Rockwood分类Ⅲ型及以上病例25例,均采用双纽扣钢板技术修复肩锁关节完全脱位,术后第2 d进行康复锻炼,术后1、3、6和12个月分别进行随访,并拍摄X线片,按照JOA肩关节疾患治疗成绩判定标准进行评分。结果:所有患者随访3～12个月,平均6个月,按照JOA标准,评分89～100分,平均96分。结论:该技术操作简单、设计合理、手术创伤小,具有复位准确、固定稳定、并发症发生率低的优点,避免了患者二次手术的费用和痛苦,是治疗肩锁关节完全脱位的有效方法。     

A functional analysis of distal biceps tendon repair: single-incision Endobutton technique vs. two-incision modified Boyd–Anderson technique

Introduction: The optimal surgical technique for a distal biceps tendon rupture repair still remains controversial. Current biomechanical evidence shows Endobutton fixation to have the highest load-to-failure testing, but clinical results of this are limited. The purpose of this study was to compare patient-oriented functional outcome between a modified Boyd–Anderson two-incision technique and repair with a single-incision Endobutton technique. Methods: All patients who underwent distal biceps tendon repair with a two-incision or Endobutton technique between 2000 and 2010 with two-year follow-up at our institution were identified. Their clinical, operative, and follow-up data was collected and analyzed. The primary outcome was a patient-oriented functional outcome measure (Disabilities of the Arm, Shoulder, and Hand: DASH). Secondary outcomes were evaluated using a subjective questionnaire. Results: Thirty-three patients were repaired with the two-incision technique and twenty-five patients had a repair with a single incision Endobutton technique. All patients receiving the two-incision repair were male, while there were 2 females who had an Endobutton procedure. There was no significant difference between the two-incision and the Endobutton groups in regards to mean DASH score (6.31 versus 5.91, p = 0.697), mean Work DASH score (10.49 versus 0.93, p = 0.166), and mean Sports DASH score (10.54 versus 9.56, p = 0.987). Regardless of technique, most patients were “extremely satisfied” (n = 42, or 72.41%) or “satisfied” (n = 10, or 17.24%) postoperatively, and returned to pre-operative activity in approximately 6 months (6.87 months versus 6.82 months, respectively) (p = 0.457). There was no significant difference in the prevalence of complications (39.39% versus 32.0%, respectively for two incision versus single incision) (p = 0.594). Conclusion: Patients from both surgical groups were satisfied with their post-operative function and had similar functional outcomes and complication rates. Both surgical techniques for distal biceps tendon repair are effective and are similarly safe methods of treatment.     

自主设计导向器辅助下 Endobutton 解剖重建喙锁韧带治疗肩锁关节脱位

2011年7月～2013年8月,我科在自主设计的导向器辅助下采用 Endobut-ton 解剖重建喙锁韧带治疗肩锁关节脱位患者,临床疗效良好,现报道如下。