切换至 "中华医学电子期刊资源库"
高级检索
中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2020, Vol. 08 ›› Issue (04) : 327 -334. doi: 10.3877/cma.j.issn.2095-5790.2020.04.007

所属专题： 文献；

论著

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
钟浩博1, 刘伟乐1, 刘正蕊2, 郑少伟1, 黄守镔1, 孙江森1, 孙春汉1, 李胜发1,†()   
  1. 1. 516001　惠州市第一人民医院骨外科
    2. 363000　漳州卫生职业学院
  • 收稿日期:2020-09-24 出版日期:2020-11-05
  • 通信作者: 李胜发
  • 基金资助:
    惠州市科技计划(2020Y049); 广东省中医药局中医药科研项目(20202215); 惠州市科技计划(2012Y053); 惠州市科技计划(2011Y045)

Correlation study of surgical trauma and clinical efficacy of triple Endobutton technique in the treatment of fresh Rockwood typeⅢacromioclavicular dislocation

Haobo Zhong1, Weile Liu1, Zhengrui Liu2, Shaowei Zheng1, Shoubin Huang1, Jiangsen Sun1, Chunhan Sun1, Shengfa Li1,†()   

  1. 1. Department of Orthopedic, Huizhou First People's Hospital, Huizhou 516001, China
    2. Zhangzhou Health Vocational College, Zhangzhou 363000, China
  • Received:2020-09-24 Published:2020-11-05
  • Corresponding author: Shengfa Li
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

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.

Haobo Zhong, Weile Liu, Zhengrui Liu, Shaowei Zheng, Shoubin Huang, Jiangsen Sun, Chunhan Sun, Shengfa Li. Correlation study of surgical trauma and clinical efficacy of triple Endobutton technique in the treatment of fresh Rockwood typeⅢacromioclavicular dislocation[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2020, 08(04): 327-334.

目的

对比AO锁骨钩钢板和三重带袢钢板技术治疗新鲜RockwoodⅢ型肩锁关节脱位患者手术创伤和临床疗效指标，并进一步在优势组中行相关性分析，探究优势组中影响临床疗效相关因素，为此类疾病手术治疗改进提供借鉴。

方法

回顾性分析惠州市第一人民医院自2018年1月至2020年5月符合新鲜Rockwood Ⅲ型肩锁关节脱位患者72例，根据手术方式不同分为AO组（A组）和三重Endobutton带袢钢板组（B组）。其中A组（n=37，F/M=12/25），平均年龄（41.30±1.02）岁；B组（n=35，F/M=13/22），平均年龄（43.36±1.15）岁。所有患者术后1 d、1周、1个月、3个月、1年均行X线检查。X线中测量喙锁间距、肩锁间距评估手术复位，视觉模拟评分（visual analogue scale/score,VAS）和Constant-Murley肩关节功能评分评估临床疗效。通过Graphpad Prism 7软件进行数据分析。年龄、返工时间、受伤至手术花费时间、手术持续时间、手术切口长度、术中出血量、VAS评分、Constant-Murley肩关节功能评分、喙锁间距和肩锁间距采用±s表示；性别、受伤位侧采用数量表示。计量资料组间比较用t检验分析，计数资料组间用卡方检验分析，相关性分析均采用Pearson相关性分析，P<0.05为差异具有统计学意义，r>0为正相关。

结果

72例患者依据12个月随访，Constant-Murley肩关节功能评分结果：A组术后1 d（46.60±0.41）分、术后1周（65.22±0.45）分和B组术后1 d（51.30±0.39）分、术后1周（75.07±0.35）分相比较，术后1 d和术后1周A组分数均明显小于B组，差异具有统计学意义（P<0.05）。VAS结果提示：A组术后1 d（6.71±0.07）分、术后1周（5.45±0.09）分、术后1个月（3.70±0.11）分和B组术后1 d（5.70±0.10）分、术后1周（3.60±0.14）分、术后1个月（2.00±0.10）分相比较，A组分数均明显大于B组，差异具有统计学意义（P<0.05）。返工时间结果示：A组（7.64±0.10）周明显长与B组（6.01±0.17）周，差异有统计学意义（P<0.05）。相关性提示：B组手术切口长度与术后1 dVAS评分（r= 0.73，P<0.05）和术后1周VAS评分（r= 0.68，P<0.05）均呈正相关。

结论

带袢钢板和锁骨钩钢板技术治疗肩锁关节脱位远期疗效相当，但相较于锁骨钩钢板内固定术而言，带袢钢板具有手术切口小、出血量少、伤口外观更好，并且在早期恢复中疼痛缓解、肩关节功能恢复更快等优势，在术后早期恢复中，带袢钢板技术通过减小手术创伤缩短患者术后疼痛时间，临床值得推广。

关键词: 肩锁关节脱位, 锁骨钩钢板, 带袢钢板, 相关性研究
Background

Acromioclavicular joint dislocation is a clinically common disease and caused by trauma violence. Patients often felt severe shoulder pain with limited mobility, seriously affecting daily life and work. Rockwood classification was mostly used in this disease. Because of its dislocation severity, damage structure characteristics and other reasons, the clinical treatment options of type III patients are often controversial. Fresh Rockwood III-IV type patients are clinically taken more surgical treatment, but the method is different. With the progress of materials and surgical concepts, new surgical techniques are becoming more widely used, and choosing a treatment that patients with this disease could get more benefits is a key issue for surgeons.

Objective

By collecting and comparing the surgical trauma and clinical efficacy indexes of AO clavicular hook plate and triple Endobutton technique in the treatment of fresh Rockwood typeⅢacromioclavicular dislocation, the correlation analysis was further carried out in the dominant group to explore the factors affecting the clinical efficacy, so as to provide reference for the improvement of surgical treatment of this kind of disease.

Methods

From January 2018 to May 2020, the data of 72 patients with fresh Rockwood typeⅢacromioclavicular dislocation were retrospectively analyzed. The patients were divided into AO clavicular hook plate group (Group A) and triple Endobutton group (Group B) according to the different operation methods. In Group A (n=37, F/M=12/25) , the average age was (41.30±1.02 ) years, and in the Group B (n=35, F/M=13/22) , the average age was (43.36±1.15) years. The X-ray examinations were performed on the 1st day, 1st week, 1st month, 3rd month and 1 year after surgery. Coracoclavicular joint distance and acromioclavicular joint distance were measured to evaluate the surgery reduction. The visual analogue scale (VAS) and Constant-Murley score were used to evaluate the clinic efficacy. The data were analyzed with Graphpad Prism 7 software. The age, rework time, injury to operation time, duration of surgery, surgical incision length, intraoperative blood loss, VAS score, Constant-Murley score, acromioclavicular joint distance and coracoclavicular joint distance were expressed as ±s. The gender and injured side were expressed quantitatively. The measurement data comparison among groups was analyzed by t test. The Chi-square test analysis and correlation analysis of enumeration data between groups was analyzed by Pearson correlation analysis. A value of P<0.05 was considered statistically significant, and r>0 was considered positively correlated.

Results

Seventy two cases were followed up for 12 months. The results of Constant-Murley scores in Group A on the 1st day (46.60±0.41) and 1st week (65.22±0.45) after surgery were statistically significant lower (P<0.05) than those in Group B on the 1 day (51.30±0.39) and 1st week (75.07±0.35) after surgery. The results of VAS scores in Group A on the 1st day (6.71±0.07) , 1st week (5.45±0.09) and 1st month (3.70±0.11) after surgery were statistically significant higher (P<0.05) than those in Group B on the 1st day (5.70±0.10) , 1st week (3.60±0.14) and 1st month (2.00±0.10) after surgery. The results of rework time in Group A (7.64±0.10) week were statistically significant longer (P<0.05) than those in Group B (6.01±0.17) week. Finally, it was positive correlation between 1 day after surgery VAS scores (r= 0.73, P<0.05) and surgical incision length, the same results were found between 1 week after surgery VAS scores (r= 0.68, P<0.05) and surgical incision length. In group B, the incision length was positively correlated with VAS score of 1st day (r= 0.73, P<0.05) and 1st week (r= 0.68, P<0.05) after surgery.

Conclusion

The long-term effect of Endobutton technique and clavicular hook plate in the treatment of acromioclavicular joint dislocation is comparable. However, the advantages of Endobutton technique include small incision, less blood loss, better looking wound, pain relieve during early rehabilitation and fast restoration. In early postoperative recovery, Endobutton technique can shorten postoperative pain duration by reducing surgical trauma, which is worthy of clinical promotion.

Key words: Acromioclavicular joint dislocation, Clavicular Hook plate, Endobutton, Relevant study
表1 患者一般资料
组别 男/女 年龄（岁，±s） 受伤位侧（左/右） 受伤至手术时间（d，±s） 重返工作时间（周，±s）
A组 25/12 41.30±1.02 21/16 5.02±0.22 7.64±0.10
B组 22/13 43.36±1.15 20/15 4.58±0.16 6.01±0.17
检验值 t=0.18 t=1.34 x2=0.00 t=1.64 t=8.26
P值 >0.05 >0.05 >0.05 >0.05 >0.05
图1 两组患者手术切口情况　图A：A组患者手术切口长度；图B：B组患者手术切口长度
表2 两组患者术中创伤结果（±s）
组别 手术持续时间（min） 手术切口长度（cm） 术中失血量（ml）
A组 45.68±0.88 7.91±0.14 62.72±1.10
B组 43.36±0.86 3.29±0.35 39.10±0.18
t值 1.89 12.56 11.29
P值 <0.05 <0.0001 <0.0001
表3 两组患者肩关节功能评分结果（分，±s）
组别 术前 术后1 d 术后1周 术后1个月 术后3个月 术后1年
A组 32.19±0.62 46.60±0.41 65.22±0.45 85.56±0.42 88.81±0.42 93.67±0.63
B组 33.03±0.63 51.30±0.39 75.07±0.35 85.97±0.49 89.65±0.60 91.02±1.30
t值 0.95 9.27 17.28 0.64 1.04 1.45
P值 >0.05 <0.05 <0.05 >0.05 >0.05 >0.05
表4 两组患者VAS评分结果（分，±s）
组别 术前 术后1 d 术后1周 术后1个月 术后3个月 术后1年
A组 7.65±0.12 6.71±0.07 5.45±0.09 3.70±0.11 1.52±0.06 1.90±0.13
B组 7.53±0.15 5.70±0.10 3.60±0.14 2.00±0.10 1.56±0.05 1.61±0.06
t值 0.61 8.45 11.51 11.79 0.57 1.75
P值 >0.05 <0.05 <0.05 <0.05 >0.05 >0.05
图2 带袢钢板组患者术前和术后1 d X线片结果　图A：术前胸部正位X线片；图B：术后1 d胸部正位X线片；图C：术前患侧肩关节正位X线片；图D：术后1 d患侧肩关节正位X线片
图3 锁骨钩钢板组患者术前和术后1 d X线片结果　图A:术前胸部正位X线片；图B:术后1 d胸部正位X线片；图C：术前患侧肩关节正位X线片;图D:术后1 d患侧肩关节正位X线片
表5 两组患者CC结果（mm，±s）
组别 术前 术后1 d 术后1周 术后1个月 术后3个月 术后1年
A组 26.09±0.80 10.66±0.16 11.18±0.17 12.58±0.10 12.59±0.09 11.69±0.27
B组 25.34±0.33 10.45±0.11 10.82±0.19 12.69±0.09 12.68±0.11 12.19±0.20
t值 0.85 1.03 1.40 0.87 0.60 1.48
P值 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表6 两组患者AC结果（mm，±s）
组别 术前 术后1 d 术后1周 术后1个月 术后3个月 术后1年
A组 16.90±0.12 5.23±0.11 5.30±0.11 5.51±0.10 5.53±0.10 5.57±0.10
B组 16.65±0.14 5.42±0.12 5.45±0.11 5.72±0.12 5.70±0.12 5.76±0.11
t值 1.33 0.90 1.13 1.44 1.14 1.30
P值 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表7 B组患者术后1 d VAS评分与手术创伤相关性
手术创伤指标 r值 P值 95% CI
手术持续时间（min） 0.68 <0.05 0.46，0.83
手术切口长度（cm） 0.73 <0.05 0.52，0.85
术中失血量（ml） 0.01 0.94 0.32，0.34
表8 B组患者术后1周VAS评分与手术创伤相关性
手术创伤指标 r值 P值 95% CI
手术持续时间（min） 0.55 <0.05 0.27，0.75
手术切口长度（cm） 0.68 <0.05 0.45，0.83
术中失血量（ml） -0.25 0.15 -0.54，0.09
[1]
薛培璘, 陈云丰. 肩锁关节脱位影像学诊断进展[J]. 国际骨科学杂志, 2015,(365):378-381.
[2]
Arirachakaran A, Boonard M, Piyapittayanun P, et al. Comparison of surgical outcomes between fixation with hook plate and loop suspensory fixation for acute unstable acromioclavicular joint dislocation: a systematic review and meta-analysis[J]. Eur J Orthop Surg Traumatol, 2016, 26(6):565-574.
[3]
Darabos N, Vlahovic I, Gusic N, et al. Is AC TightRope fixation better than Bosworth screw fixation for minimally invasive operative treatment of Rockwood III AC joint injury?[J]. Injury, 2015, 46:S113-S118.
[4]
Kim AC, Matcuk G, Patel D, et al. Acromioclavicular joint injuries and reconstructions: a review of expected imaging findings and potential complications[J]. Emerg Radiol, 2012, 19(5):399-413.
[5]
何继业, 张家红, 蔡贵泉, 等.关节镜辅助下三束重建治疗急性Rockwood Ⅲ型肩锁关节脱位[J/CD]. 中华肩肘外科电子杂志,2019,7(4):294-300.
[6]
Kaplan LD, Flanigan DC, Norwig J, et al. Prevalence and Variance of Shoulder Injuries in Elite Collegiate Football Players[J]. Am J Sports Med, 2005, 33(8):1142-1146.
[7]
Kelly BT. Shoulder injuries to quarterbacks in the national football league[J]. Am J Sports Med, 2004, 32(2):328-331.
[8]
Beitzel K, Mazzocca AD, Bak K, et al. ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries[J]. Arthroscopy, 2014, 30(2):271-278.
[9]
Maffulli N, Longo UG, Spiezia F, et al. Sports Injuries in Young Athletes: Long-Term Outcome and Prevention Strategies[J]. Phys Sportsmed, 2010, 38(2):29-34.
[10]
许树柴, 袁凯, 林定坤,等. 肩锁关节脱位治疗进展[J]. 中国矫形外科杂志, 2010, 18(14):1180-1183.
[11]
葛喆, 张新潮. 肩锁关节脱位的手术治疗进展[J/CD]. 中华肩肘外科电子杂志, 2017, 5(4):308-312.
[12]
Giuseppe LU, Mauro C, Giacomo R, et al. Surgical versus conservative management of Type III acromioclavicular dislocation: a systematic review[J]. Bri Med Bull, 2017,122(1):31-49.
[13]
Schaefer FK, Schaefer PJ, Brossmann J, et al. Experimental and clinical evaluation of acromioclavicular joint structures with new scan orientations in MRI[J]. European Radiology, 2006, 16(7):1488-1493.
[14]
赵立连, 张耀南, 尹自龙,等. 全关节镜下双纽扣钢板固定技术治疗急性肩锁关节脱位的初步临床疗效观察[J/CD]. 中华关节外科杂志（电子版）, 2010, 4(1): 18-24.
[15]
何洁铭, 王嘉.急性肩锁关节脱位Rockwood Ⅲ～Ⅴ型手术治疗中锁骨钩钢板和袢钢板应用效果的比较分析[J/CD]. 中华肩肘外科电子杂志,2020,8(1):11-15.
[16]
熊俊伟, 熊志伟, 邹腾.锁骨钩钢板与双Endobutton钢板治疗肩锁关节脱位患者的临床效果[J]. 医疗装备, 2020, 33(15) : 104-106.
[17]
宫玉锁, 蒋国鹏, 谢兴文,等. 肩锁关节损伤的治疗进展[J]. 中国中医骨伤科杂志, 2016, 24(10):79-82.
[18]
Hiroshi H, Satoshi I, Kazumasa A, et al. Arthroscopic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Dislocation[J]. J Nippon Med Sch, 2018, 85(3):166-171.
[19]
Flinkkila 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.
[20]
许永康, 舒占坤, 张羽. 锁骨钩钢板治疗肩锁关节脱位并发骨折的探讨[J/CD]. 中华肩肘外科电子杂志, 2015,3(3):164-166.
[21]
Sircana G, Saccomanno MF, Mocini F, et al. Anatomic reconstruction of the acromioclavicular joint provides the best functional outcomes in the treatment of chronic instability[J]. Knee Surg Sports Traumatol Arthrosc, 2020,27:1-12.
[22]
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):e13-e15.
[23]
房燚, 赵文志, 潘德悦, 等.肩锁关节脱位研究：如何达到解剖复位和持续性稳定及关节微动[J]. 中国组织工程研究,2020,24(5):796-802.
[24]
Struhl S, Wolfson TS.Continuous Loop Double Endobutton Reconstruction for Acromioclavicular Joint Dislocation[J]. Am J Sports Med, 2015,43(10):2437-2444.
[25]
徐海波, 薛骋, 宋李军,等. 双束Endobutton解剖重建喙锁韧带治疗肩锁关节脱位的早期随访研究[J/CD]. 中华肩肘外科电子杂志, 2019, 7(1):55-60.
[26]
Flinkkila TE, Ihanainen E.Results of Arthroscopy-Assisted TightRope Repair of Acromioclavicular Dislocations[J]. Shoulder Elbow, 2014,6(1):18-22.
[27]
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.
[28]
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.
[29]
张建华, 李新志, 王光勇, 等.RockwoodⅢ型肩锁关节脱位的治疗进展[J]. 中华骨科杂志,2010(6):299-302.
[30]
刘伟乐, 李胜发, 郑少伟,等. 锁骨钩钢板与三重带袢纽扣钢板治疗肩锁关节脱位的对比[J/CD]. 中华关节外科杂志（电子版）, 2019, 13(3):267-272.
[31]
黄超, 林木良, 李桓毅,等. TightRope与钩钢板治疗急性肩锁关节脱位的对比[J]. 中国矫形外科杂志, 2018, 26(24):28-32.
[1] 高山, 孙乾坤, 王敬威, 胡梅, 郭艳幸. 膝骨关节炎与相关金属蛋白酶的基因多态性关联研究[J]. 中华关节外科杂志(电子版), 2020, 14(04): 454-460.
[2] 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.
[3] 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.
[4] 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.
[5] 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.
[6] 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.
[7] 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.
[8] 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.
[9] 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.
[10] 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.
[11] 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.
[12] 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.
[13] 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.
[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

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号