[1]沈哲源,彭巧英,李恒,等.双袢与“Y”形三袢TightRope纽扣钢板内固定治疗新鲜RockwoodⅢ～Ⅴ型肩锁关节脱位的对比研究[J].中医正骨,2024,36(07):22-27,54.
　SHEN Zheyuan,PENG Qiaoying,LI Heng,et al.A comparative study of double-loop versus Y-shaped triple-loop TightRope button plate internal fixation for treatment of Rockwood typeⅢ-Ⅴ fresh acromioclavicular joint dislocation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(07):22-27,54.
点击复制

双袢与“Y”形三袢TightRope纽扣钢板内固定治疗新鲜RockwoodⅢ～Ⅴ型肩锁关节脱位的对比研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年07期
页码:
22-27,54
栏目:
临床研究
出版日期:
2024-07-20

文章信息/Info

Title:
A comparative study of double-loop versus Y-shaped triple-loop TightRope button plate internal fixation for treatment of Rockwood typeⅢ-Ⅴ fresh acromioclavicular joint dislocation
作者:
沈哲源; 彭巧英; 李恒; 郭松华; 张占丰
湖州市第一人民医院,浙江 湖州 313000
Author(s):
SHEN Zheyuan; PENG Qiaoying; LI Heng; GUO Songhua; ZHANG Zhanfeng
The First People's Hospital of Huzhou,Huzhou 313000,Zhejiang,China
关键词:
肩锁关节;  肩脱位;  TightRope纽扣钢板;  喙锁韧带重建;  临床试验
Keywords:
acromioclavicular joint;  shoulder dislocation;  TightRope button plate;  coracoclavicular ligament reconstruction;  clinical trial
摘要:
目的:比较双袢与“Y”形三袢TightRope纽扣钢板内固定治疗新鲜RockwoodⅢ～Ⅴ型肩锁关节脱位的临床疗效及安全性。方法:回顾性分析2016年1月至2019年5月收治的74例肩锁关节脱位患者的病例资料,其中采用双袢TightRope纽扣钢板内固定治疗者43例(双袢组),采用“Y”形三袢TightRope纽扣钢板内固定治疗者31例(三袢组)。比较2组患者的手术时间、喙锁间距差值、肩部疼痛视觉模拟量表(visual analogue scale,VAS)评分、加州大学洛杉矶分校(University of California Los Angeles,UCLA)肩关节量表评分、Constant-Murley肩关节评分及并发症发生率。结果:双袢组的手术时间短于三袢组[(31.37±4.03)min,(50.94±5.66)min,t=17.387,P=0.000)]。术后6周、24周、1年以及末次随访时,双袢组的喙锁间距差值均高于三袢组[(1.60±1.76)mm,(0.26±0.23)mm,t=4.220,P=0.000;(2.11±2.11)mm,(0.31±0.31)mm,t=4.695,P=0.000;(2.19±2.19)mm,(0.38±0.37)mm,t=4.536,P=0.000;(2.21±2.21)mm,(0.40±0.39)mm,t=4.499,P=0.000]。末次随访时,2组患者的肩部疼痛VAS评分均较术前降低(t=32.538,P=0.000; t=24.849,P=0.000),2组患者的肩部疼痛VAS评分比较,差异无统计学意义[(0.56±0.70)分,(0.55±0.72)分,t=0.058,P=0.954]。末次随访时,2组患者的UCLA肩关节量表评分均较术前增高(t=-108.72,P=0.000; t=-52.267,P=0.000),双袢组的UCLA肩关节量表评分低于三袢组[(47.02±1.71)分,(49.32±2.77)分,t=-2.490,P=0.015]。末次随访时,2组患者的Constant-Murley肩关节评分均较术前增高(t=-63.617,P=0.000; t=-67.607,P=0.000),双袢组的Constant-Murley肩关节评分低于三袢组[(94.58±2.70)分,(94.61±3.12)分,t=-2.135,P=0.036]。双袢组2例发生锁骨骨溶解,三袢组1例发生切口感染。2组患者并发症发生率比较,差异无统计学意义(P=1.000)。结论:双袢与“Y”形三袢TightRope纽扣钢板内固定治疗新鲜RockwoodⅢ～Ⅴ型肩锁关节脱位,均能减轻肩关节疼痛,但双袢固定的手术时间更短、“Y”形三袢固定的肩关节功能恢复得更好。
Abstract:
Objective:To compare the clinical outcomes and safety of double-loop versus Y-shaped triple-loop TightRope button plate internal fixation in treatment of Rockwood typeⅢ-Ⅴfresh acromioclavicular joint dislocation(ACJD).Methods:The medical records of 74 ACJD patients recruited from January 2016 to May 2019 were retrospectively analyzed.Forty-three patients were treated with double-loop TightRope button plate internal fixation(double-loop group),and 31 ones with Y-shaped triple-loop TightRope button plate internal fixation(triple-loop group).The operative time,coracoclavicular distance(CCD)difference,shoulder pain visual analogue scale(VAS)score,University of California Los Angeles(UCLA)shoulder score,Constant-Murley shoulder score,and postoperative complications were compared between the 2 groups.Results:The operative time was shorter in double-loop group compared to triple-loop group(31.37±4.03 vs 50.94±5.66 minutes,t=17.387,P=0.000).The difference of CCD was larger in double-loop group compared to triple-loop group at postoperative week 6,week 24,month 12 and the last follow-up(1.60±1.76 vs 0.26±0.23 mm,t=4.220,P=0.000; 2.11±2.11 vs 0.31±0.31 mm,t=4.695,P=0.000; 2.19±2.19 vs 0.38±0.37 mm,t=4.536,P=0.000; 2.21±2.21 vs 0.40±0.39 mm,t=4.499,P=0.000).The shoulder pain VAS score decreased in the 2 groups at the last follow-up compared to pre-operation(t=32.538,P=0.000; t=24.849,P=0.000),and the difference was not statistically significant between the 2 groups(0.56±0.70 vs 0.55±0.72 points,t=0.058,P=0.954).The UCLA shoulder score increased in the 2 groups at the last follow-up compared to pre-operation(t=-108.72,P=0.000; t=-52.267,P=0.000),and it was lower in double-loop group compared to triple-loop group(47.02±1.71 vs 49.32±2.77 points,t=-2.490,P=0.015).The Constant-Murley shoulder score increased in the 2 groups at the last follow-up compared to pre-operation(t=-63.617,P=0.000; t=-67.607,P=0.000),and it was lower in double-loop group compared to triple-loop group(94.58±2.70 vs 94.61±3.12 points,t=-2.135,P=0.036).Two patients suffered from clavicular osteolysis in double-loop group,and 1 patient experienced incision infection in triple-loop group.There was no statistical difference in complication incidences between the 2 groups(P=1.000).Conclusion:Both double-loop and Y-shaped triple-loop TightRope button plate internal fixation can alleviate the shoulder pain in treatment of Rockwood typeⅢ-Ⅴfresh ACJD.However,the former requires shorter operative time,while the latter achieves better outcome in shoulder function recovery.

参考文献/References:

[1] CHILLEMI C,FRANCESCHINI V,DEI GIUDICI L,et al.Epidemiology of isolated acromioclavicular joint dislo-cation[J].Emerg Med Int,2013,2013:171609.
[2] 鲍飞龙,姬广伟,亢世杰,等.肩锁韧带重建与锁骨钩板肩锁关节内固定在带线锚钉重建喙锁韧带治疗肩锁关节脱位中的疗效比较[J].中华创伤骨科杂志,2021,23(8):717-722.
[3] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:69.
[4] ANGST F,SCHWYZER H K,AESCHLIMANN A,et al.Measures of adult shoulder function:Disabilities of the Arm,Shoulder,and Hand Questionnaire(DASH)and its short version(QuickDASH),Shoulder Pain and Disability Index(SPADI),American Shoulder and Elbow Surgeons(ASES)Society standardized shoulder assessment form,Constant(Murley)Score(CS),Simple Shoulder Test(SST),Oxford Shoulder Score(OSS),Shoulder Disability Questionnaire(SDQ),and Western Ontario Shoulder Instability Index(WOSI)[J].Arthritis Care Res(Hoboken),2011,63(Suppl 11):S174-S188.
[5] MANTRIPRAGADA S,BHAGWANI S,PEH W C,et al.A-cromioclavicular joint injuries:Imaging and management[J].J Med Imaging Radiat Oncol,2020,64(6):803-813.
[6] LEE S J,EOM T W,HYUN Y S.Complications and frequency of surgical treatment with AO-type hook plate in shoulder trauma:a retrospective study[J].J Clin Med,2022,11(4):1026.
[7] GOWD A K,LIU J N,CABARCAS B C,et al.Current concepts in the operative management of acromioclavicular dislocations:a systematic review and meta-analysis of operative techni-ques[J].Am J Sports Med,2019,47(11):2745-2758.
[8] THOMAS K,LITSKY A,JONES G,et al.Biomechanical comparison of coracoclavicular reconstructive techniques[J].Am J Sports Med,2011,39(4):804-810.
[9] CHANG H M,WANG C H,HSU K L,et al.Does Weaver-Dunn procedure have a role in chronic acromioclavicular dislocations?A meta-analysis[J].J Orthop Surg Res,2022,17(1):95.
[10] WELLMANN M,KEMPKA J P,SCHANZ S,et al.Coracoclavicular ligament reconstruction:biomechanical comparison of tendon graft repairs to a synthetic double bundle augmentation[J].Knee Surg Sports Traumatol Arthrosc,2009,17(5):521-528.
[11] LOBAO M H,CANHAM R B,MELVANI R T,et al.Synthetic coracoclavicular ligament vs.coracoclavicular suspensory construct for treatment of acromioclavicular dislocation:a biomechanical study[J].J Shoulder Elbow Surg,2020,29(7):1440-1449.
[12] SACCOMANNO M F,SIRCANA G,CARDONA V,et al.Biologic and synthetic ligament reconstructions achieve better functional scores compared to osteosynthesis in the treatment of acute acromioclavicular joint dislocation[J].Knee Surg Sports Traumatol Arthrosc,2021,29(7):2175-2193.
[13] SHEN G,SUN S,TANG C,et al.Comparison of the TightRope system versus hook plate in acute acromioclavicular joint dislocations:a retrospective analysis[J].Sci Rep,2021,11(1):11397.
[14] SHIN S J,KIM N K.Complications after arthroscopic coracoclavicular reconstruction using a single adjustable-loop-length suspensory fixation device in acute acromioclavicular joint dislocation[J].Arthroscopy,2015,31(5):816-824.
[15] 熊昌文,赵喆.肩锁关节脱位治疗的研究进展[J].中医正骨,2020,32(6):44-48.
[16] 黎金焕,何晖,陈庆航,等.肩锁关节的形态学特征研究[J].中医正骨,2023,35(8):26-30.
[17] ÖZCAFER R,ALBAYRAK K,LAPÇIN O,et al.Early clinical and radiographic results of fixation with the TightRope device for Rockwood type V acromioclavicular joint dislocation:A retrospective review of 15 patients[J].Acta Orthop Traumatol Turc,2020,54(5):473-477.
[18] LIU S,LI C,SONG Z,et al.Comparison of open reduction and fixation with hook plate and modified closed reduction and fixation with tightrope loop plate for treatment of rockwood type III acromioclavicular joint dislocation[J].BMC Musculoskelet Disord,2022,23(1):301.
[19] 张传开,郝亮,陈强,等.带线锚钉重建喙锁韧带在解剖锁定钢板内固定治疗锁骨远端NeerⅡB型骨折中的应用[J].中医正骨,2022,34(11):7-13.
[20] THANGARAJU S,TAUBER M,HABERMEYER P,et al.Clavicle and coracoid process periprosthetic fractures as late post-operative complications in arthroscopically assisted acromioclavicular joint stabilization[J].Knee Surg Sports Traumatol Arthrosc,2019,27(12):3797-3802.
[21] 马滚韶,罗裕强,徐勤.穿梭导线小隧道Endobutton技术治疗Rockwood Ⅲ型急性肩锁关节脱位的疗效分析[J].中华创伤骨科杂志,2021,23(6):535-538.
[22] RENAUD M,CAUBRIÈRE M,LANCIGU R,et al.Management of acute grade IV and greater acromioclavicular dislocations:Open acromioclavicular brace versus arthroscopic double DogBone endobutton[J].Orthop Traumatol Surg Res,2024,110(1):103635.
[23] LI F,LI Y,LU Y,et al.Clinical outcome of a modified coracoid tunnel-free coracoclavicular sling technique with remnant preservation for the treatment of high-grade acromioclavicular joint separation:a report of 48 cases with 2 to 5 years of follow-up[J].Am J Sports Med,2021,49(6):1612-1618.
[24] HU F,HAN S,LIU F,et al.A modified single-endobutton technique combined with nice knot for treatment of Rockwood type III or V acromioclavicular joint dislocation[J].BMC Musculoskelet Disord,2022,23(1):15.
[25] CIVAN O,ATMACA H,UGUR L.Biomechanical comparison of double versus triple button reconstruction techniques in patients with acromioclavicular joint dislocation[J].Int J Med Robot,2020,16(1):e2057.
[26] JOSHI A,BASUKALA B,SINGH N,et al.Arthroscopy-assisted all-suture coracoclavicular and acromioclavicular joint stabilization in acute acromioclavicular joint injuries[J].Arthrosc Tech,2021,10(5):e1293-e1306.

相似文献/References:

[1]徐洪伟,康信勇,贺振年,等.带袢钢板内固定治疗急性肩锁关节脱位[J].中医正骨,2015,27(11):48.
[2]孙辽军,卢迪,余贤斌,等.喙突骨隧道位置对双Endobutton钢板重建 术后喙锁韧带力学性能的影响[J].中医正骨,2015,27(05):1.
　SUN Liaojun,LU Di,YU Xianbin,et al.Effect of location of coracoid tunnel on the mechanical property of coracoclavicular ligament after reconstruction using double Endobutton[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(07):1.
[3]田玉鹏,汤善兵,褚向明,等.关节镜下Endobutton钢板联合指骨钢板内固定治疗 新鲜RockwoodⅢ型肩锁关节脱位[J].中医正骨,2015,27(05):21.
[4]卢启贵,李长树,黄东红,等.关节镜下Endobutton钢板内固定治疗肩锁关节脱位[J].中医正骨,2015,27(05):23.
[5]李琳,李峰,陈华.肩胛固定旋复法治疗肩关节前脱位[J].中医正骨,2016,28(09):59.
[6]赵胜春,吴国林.Endobutton钢板内固定治疗急性肩锁关节脱位[J].中医正骨,2018,30(02):72.
[7]熊昌文,赵喆.肩锁关节脱位治疗的研究进展[J].中医正骨,2020,32(06):44.
[8]黎金焕,何晖,陈庆航,等.肩锁关节的形态学特征研究[J].中医正骨,2023,35(08):26.
　LI Jinhuan,HE Hui,CHEN Qinghang,et al.A study of morphological characteristics of acromioclavicular joints[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(07):26.

备注/Memo

备注/Memo:
基金项目:浙江省医药卫生科技计划项目(2024KY1649)
通讯作者:张占丰 E-mail:335980557@qq.com
更新日期/Last Update: 1900-01-01