雙Endobutton鋼板與鎖骨鉤鋼板治療肩鎖關節脫位的臨床療效對比研究

項衛衛+倫韋丹+曾文添+何澄+賴金良

【摘要】 目的：探討雙Endobutton鋼板與鎖骨鉤鋼板治療肩鎖關節脫位的臨床效果。方法：回顧性分析2014年1月-2017年1月本科室分別應用雙Endobutton鋼板與鎖骨鉤鋼板治療肩鎖關節脫位的患者26例。按照手術方式分為雙Endobutton鋼板組（A組）14例，和鎖骨鉤鋼板組（B組）12例。比較兩組手術時間及術中出血量，術前與術后6個月均采用疼痛視覺模擬評分（VAS）、Constant評分對兩組肩關節功能進行評價。結果：26例患者均獲得隨訪，A組手術時間、術中出血量均多于B組，比較差異有統計學意義（P<0.05）。術后6個月A組平均Constant評分為（92.7±4.5）分，高于B組的（88.4±4.2）分，比較差異有統計學意義（P<0.05）。術后6個月兩組VAS評分比較，差異無統計學意義（P>0.05）。結論：雙Endobutton鋼板與鎖骨鉤鋼板在治療肩鎖關節脫位有各自優缺點均取得滿意療效，但是雙Endobutton鋼板術后肩周疼痛、肩峰撞擊等并發癥少，對肩關節活動影響小，有利于肩關節功能恢復。

【關鍵詞】 肩鎖關節脫位； 雙Endobutton鋼板； 鎖骨鉤鋼板

【Abstract】 Objective：To investigate the clinical efficacy of double Endobutton plate and clavicular hook plate in treatment of acromioclavicular joint dislocation.Method：26 cases of acromioclavicular dislocation from January 2014 to January 2017 were treated by double Endobutton plate and clavicular hook plate were retrospectively analyzed.According to the operation mode，they were divided into 14 cases of double Endobutton plate group（group A），and 12 cases of clavicular hook plate group（group B）.The operation time and intraoperative blood loss were compared between two groups，and visual analogue scale（VAS） and constant score were used to evaluate shoulder function scores of two groups before and 6 months after operation.Result：26 patients were followed up，the operation time and bleeding volume in group A were more than those of group B，the differences were statistically significant（P<0.05）.6 months after operation，the average constant score of group A was（92.7±4.5） points，with was higher than（88.4±4.2）points of group B，the difference was statistically significant（P<0.05）.6 months after operation，VAS score of two groups were compared，the difference was no statistically significant（P>0.05）.Conclusion：Double Endobutton plate and clavicular hook plate in treatment of acromioclavicular joint dislocation have their respective advantages and disadvantages are satisfactory，but double Endobutton plate of postoperative shoulder pain，impingement complications，little influence on activity of the shoulder joint，is conducive to the recovery of shoulder joint function.

【Key words】 Acromioclavicular joint dislocation； Double Endobutton plate； Clavicular hook plate

First-authors address：The First Affiliated Hospital of Gannan Medical College，Ganzhou 341000，China

doi：10.3969/j.issn.1674-4985.2017.33.011

肩鎖關節是由鎖骨的肩峰端和肩胛骨的肩峰關節面、關節滑囊、纖維關節囊構成的一個微動關節，參與肩關節的聯合運動，對上肢活動的協同性起著重要作用。肩鎖關節脫位是臨床上較為常見的損傷，多發生于青壯年，約占肩部損傷的12%[1-2]，主要由交通事故、摔傷、運動傷等原因造成。Rockwood將肩鎖關節脫位分為6型，其中Ⅰ～Ⅱ型多為保守治療，Ⅲ～Ⅵ型首選手術治療。臨床上治療肩鎖關節脫位的方法眾多，包括克氏針內固定、螺釘內固定、鎖骨鉤鋼板內固定等。其中鎖骨鉤鋼板內固定是目前臨床上較常用的一種方法，有著手術操作安全、簡單，固定牢固等優勢，但是術后常引起肩峰撞擊、肩關節疼痛、肩關節活動受限、肩峰骨溶解等一系列并發癥[3]。……