通过回顾性队列分析，系统比较两种术式在手术参数、功能恢复及并发症等方面的差异。

本文旨在评估2020年1月至2023年6月淄博市中心医院创伤骨科收治的46例RockwoodⅢ型和Ⅳ型肩锁关节脱位患者的临床资料。对46例患者开展了回顾性研究，所有手术均由同一手术小组完成，根据手术方式不同将46例肩锁关节脱位患者分为单切口双Endobutton带袢钢板内固定术组23例，其中RockwoodⅢ型12例、RockwoodⅣ型11例；锁骨钩钢板内固定术组23例，其中RockwoodⅢ型13例、RockwoodⅣ型10例。比较两组手术时长，切口长度，术中出血量，术前、术后1个月、术后3个月、术后6个月的肩锁关节间隙（acromioclavicular distance,ACD）和喙锁关节间隙（coracoclavicular distance,CCD）以及术后1个月、3个月、6个月双Endobutton带袢钢板内固定术组与锁骨钩钢板内固定术组的视觉模拟评分（visual analogue scale,VAS）和Constant—Murley功能评分（Constant-Murley score,CMS）。比较两组术后1年并发症的发生情况。

两组手术均顺利完成，获得随访时间均大于1年。双Endobutton带袢钢板内固定术组手术时长（49.00±3.84）min、切口长度（45.29±8.16）mm均短于锁骨钩钢板内固定术组（67.63±5.14）min、（69.87±5.41）mm，差异有统计学意义（P<0.05）；锁骨钩钢板内固定术组术中出血量（81.65±5.05）ml比双Endobutton带袢钢板内固定术组（61.12±2.80）ml多，差异有统计学意义（P<0.05）；术后1、3、6个月时，VAS评分双Endobutton带袢钢板内固定术组[（2.98±0.41）分、（2.37±0.29）分、（1.44±0.23）分]均低于锁骨钩钢板内固定术组[（4.00±0.52）分、（2.80±0.42）分、（1.67±0.14）分]，差异有统计学意义（P<0.05）；Constant-Murley评分双Endobutton带袢钢板内固定术组[（73.43±1.83）分、（84.71±1.81）分、（88.24±1.58）分]均高于锁骨钩钢板内固定术组[（65.71±2.27）分、（79.30±1.99）分、（81.69±1.93）分]，差异有统计学意义（P<0.05）。双Endobutton带袢钢板内固定术组和锁骨钩钢板内固定术组术后都发生了不同的并发症，差异有统计学意义（P<0.05）。

双Endobutton系统通过"悬吊-张力带"双重机制实现解剖重建，其动态固定特性更符合肩锁关节生理运动学。与钩钢板的刚性固定相比，减少应力遮挡效应。从并发症来看，实验组并发症多与材料特性相关（金属疲劳、界面微动），而对照组并发症多源于机械压迫（肩峰撞击综合征）。因此建立分型导向的并发症预防体系：因锁骨钩钢板对局部施加力的作用，作者推测对骨质疏松患者优先选择Endobutton，对高活动需求者推荐结合加强缝合技术。双Endobutton术式在微创性、功能恢复方面展现显著优势。未来研究应着重开发智能导航系统以优化隧道定位精度，并通过有限元分析改进钢板构型设计。

The stability of the acromioclavicular joint depends on a three-level anatomical defense system: Bony interlocking structure (the acromioclavicular joint surface forms a concave-convex matching shape) , static stability system (the four-dimensional tension network of the acromioclavicular ligament bears 82% of the initial anti-displacement load, and the coracoclavicular ligament complex provides vertical suspension function) , and dynamic stability system (the trape-deltoid muscle fascia generates dynamic compressive force Reaching 2.1 times the body weight during outreach. A pathological dislocation occurs when high-energy trauma interrupts ligament continuity (MRI shows that the Angle of conical ligament rupture is >25°) . There are significant differences in the stepwise treatment strategies based on the Rockwood classification: In types I-II, conservative treatment (dynamic brace fixation combined with biofeedback training) is adopted chiefly, while in cases of types IV-VI, surgical intervention is mainly required. For controversial type III dislocation, the failure rate of conservative treatment for manual workers reached 41.2%, prompting 56.3% of cases to choose early surgical intervention. Although the traditional clavicle hook plate technique can shorten the braking period through rigid fixation, it causes characteristic complications: unhooking, shoulder joint stiffness, intractable shoulder joint pain, acromial impact, subacromial osteolysis, etc. Persistent shoulder joint dysfunction (CMS<65) occurred in a few cases. In contrast, the single-incision double Endobutton loop plate technique achieved anatomical reconstruction. Its elastic fixation characteristic increased the CMS score to 84.7±1.8 three months after the operation (19.3% higher than the hook plate group, P=0.004) and reduced the incidence of complications such as acromial impact. However, the data of this group showed that the failure rate of the internal fixation device was 8%. A comparative study of 46 cases of Rockwood type III-IV (2020-2023) revealed the core contradiction: The Endobutton technique sacrifices the initial fixation strength while reducing mechanical complications. This discovery suggests that a new hybrid fixation system needs to be developed to enhance the fixation strength of the Endobutton.

This study conducted a retrospective cohort analysis to systematically compare the differences between the two surgical methods regarding surgical parameters, functional recovery, and complications.

This article aims to evaluate the clinical data of 46 patients with Rockwood type III and type IV acromioclavicular joint dislocation admitted to the Department of Orthopedics and Traumatology of Zibo Central Hospital from January 2020 to June 2023. We conducted a retrospective study on these patients. The same surgical team performed all surgeries. According to different surgical methods, 46 patients with acromioclavicular joint dislocation were divided into 23 cases in the single-incision double Endobutton loop plate internal fixation group, 12 in Rockwood type III, and 11 in Rockwood type IV. In the clavicle hook plate internal fixation group, there were 23 cases, including 13 of Rockwood type III and 10 of Rockwood type IV. The two groups' operation duration, incision length, and intraoperative blood loss were compared. The acromioclavicular distance (ACD) and coracoclavicular distance (CCD) before the operation, 1 month, 3 months, and 6 months after the operation distance, and the visual analogue scores (VAS) of the double-Endobutton plate internal fixation group and the clavicle hook plate internal fixation group at 1 month, 3 months and 6 months after the operation scale, VAS and Constant-murley functional score (CMS) were compared. The complications in the two groups were compared one year after the operation.

Both groups of surgeries were completed, and the follow-up time obtained was more than one year for both. The operation duration (49.00±3.84) min and incision length (45.29±8.16) mm in the double Endobutton loop plate internal fixation group were both shorter than those in the clavicle hook plate internal fixation group [ (67.63±5.14) min and (69.87±5.41) mm] , and the differences were comparable (P<0.05) . The intraoperative blood loss in the clavicle hook plate internal fixation group (81.65±5.05) ml was more than that in the double Endobutton loop plate internal fixation group (61.12±2.80) ml, and the difference was comparable (P<0.05) . At 1, 3, and 6 months after the operation, The VAS double Endobutton loop plate internal fixation groups [ (2.98±0.41) points, (2.37±0.29) points, (1.44±0.23) points] were all lower than those in the clavicle hook plate internal fixation groups [ (4.00±0.52) points, (2.80±0.42) points, (1.67±0.14) points] . The differences were comparable (P<0.05) . The Constant-Murley scores in the double Endobutton loop plate internal fixation group [ (73.43±1.83) points, (84.71±1.81) points, (88.24±1.58) points] were all higher than those in the clavicular hook plate internal fixation group [ (65.71±2.27) points, (79.30±1.99) points, (81.69±1.93) points There was a significant difference in , and the differences were comparable (P<0.05) . Different complications occurred in both the double Endobutton loop plate internal fixation group and the clavicle hook plate internal fixation group after the operation, with significant differences that were comparable (P<0.05) .

The dual Endobutton system achieves anatomical reconstruction through the dual mechanism of "suspension-tension band" and its dynamic fixation characteristics are more in line with the physiological kinematics of the acromioclavicular joint. Compared with the rigid fixation of the hook steel plate, the stress shielding effect is reduced. From the perspective of complications, the complications in the experimental group were mainly related to material properties (metal fatigue, interfacial frets) , while the complications in the control group were caused mainly by mechanical compression (acromial impingement syndrome) . Therefore, a type-oriented complication prevention system should be established. Due to the effect of the clavicle hook plate on local force application, we speculate that Endobutton should be given priority for patients with osteoporosis, and for those with high activity requirements, it is recommended to combine with enhanced suture techniques. The double Endobutton surgical method shows significant advantages in minimally invasive and functional recovery. Future research should focus on developing intelligent navigation systems to optimize the positioning accuracy of tunnels and improve the configuration design of steel plates through finite element analysis.