经喙突基底小切口TightRope固定治疗新鲜肩锁关节脱位
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作者Author单位AddressE-Mail
沈杰枫* Shen Jie-feng 无锡市中医医院骨伤科 Wuxi traditional Chinese medicine hospital 1967028733@qq.com 
朱义用 Zhu Yi-yong 无锡市中医医院骨伤科  
严松鹤 Yan Song-he 无锡市中医医院骨伤科  
刘勇 Liu Yong 无锡市中医医院骨伤科  
华臻 Hua Zhen 无锡市中医医院骨伤科  
期刊信息:《中国骨伤》年,第卷,第期,第-页
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中文摘要:目的:探讨小切口TightRope固定治疗新鲜肩锁关节脱位的方法与疗效。 方法:回顾分析2016年1月~2018年5月采用喙突基底小切口,行TightRope固定治疗28例新鲜肩锁关节脱位临床资料: 男20例,女8例;年龄26~87岁,平均51.3岁;统计手术时间、肩功能恢复时间、术后并发症情况;评估术后即刻复位效果、末次随访肩关节Karlsson功能评价,以spss20.0软件Pearson分析二者相关性;比较本组28例TightRope固定与作者早期报道46例Endobutton固定组末次随访肩关节Karlsson功能评价。 结果 28例患者平均手术时间66.5分钟;术后随访11~20月(平均16.7月), 肩功能恢复正常时间为2~7个月(平均4.0月);随访期内,1例患者锁骨钢板部位发生骨溶解及复位丢失;其余未出现再脱位、纽扣钢板脱出等并发症。术后即刻复位效果:复位不足6例,完全复位17例,复位过度5例;末次随访肩关节Karlsson功能评价:优21例,良6例,差1例;Pearson分析 r=0.060 ,提示新鲜肩锁关节脱位手术即刻复位效果与末次随访患肩关节Karlsson功能评价无明显相关性。28例TightRope固定与46例Endobutton固定组术后末次随访患肩关节Karlsson功能评价对比无统计学差异。 结论 经喙突基底小切口行TightRope固定治疗新鲜肩锁关节脱位操作简便,患者功能恢复优良。新鲜肩锁关节脱位手术即刻复位效果5mm以内的轻微差异与术后末次随访患肩关节Karlsson功能评价无明显相关性。临床随访建议关注复位丢失以及锁骨钢板部位骨溶解。
【关键词】肩锁关节脱位  TightRope  微创性  喙突基底切口  锁骨骨溶解
 
The TightRope internal fixation through a tiny incision over the coracoid-base in the treatment of acromioclavicular dislocation
ABSTRACT  [Objective]In order to explore the clinical experience and evaluate the efficacy of the treatment in acute acromioclavicular dislocations with the TightRope internal fixation through a tiny incision over the coracoid-base. [Methods] From January 2016 to May 2018, in our department a total of 28 acute acromioclavicular dislocations were treated with the TightRope internal fixation through a single tiny incision over the coracoid base,the data of the 28 patients were analyzed retrospectively in this study:Including 20 males and 8 females, ranging from 26 to 87 years old, with an average age of 51.3 years;The average operative duration were measured,the shoulder function recovery time and the complications after operation were assessed at follow-ups;Early reduction grades and postoperative shoulder functional outcomes according to the Karlsson evaluation criteria in the last follow-up were assessed ,the correlation between them were statistically analysised by spss20.0. Compared the shoulder functional results according to the Karlsson evaluation criteria in the last follow-up between 28 TightRope fixation cases and 46 Endobutton fixation cases which had been reported by authors early. [Results]The average operative duration was 66.5 minutes;The patients obtained an average follow-up of 16.7 months(range 11 to 20 months ),all shoulders' function recovered in 2~7 months (average of 4.0 months) after the operation;Clavicular osteolysis and reduction loss occurred in one patient, no more patients suffered dislocation again or button-plate-pulled-out during the follow-ups. Early reduction grades of the 28 patients:6 got insufficient reduction grades,17 got appropriate grades,5 got excessive grades;According to the Karlsson shoulder function evaluation criteria,21 patients obtained the excellent result,6 got good and 1 got poor at follow-ups. Pearson analysis r=0.060 suggested that there was no significant correlation between the early reduction grades of acute acromioclavicular dislocations and shoulder functional outcomes according to the Karlsson evaluation criteria in the last follow-up. There was no significant difference in shoulder functional results according to the Karlsson evaluation criteria between 28 TightRope fixation and 46 Endobutton fixation groups at the last follow-up. [Conclusions]The treatment in acromioclavicular dislocation with the TightRope fixation through a tiny incision over the coracoid-base is effective and easy to operate, which allows early exercise and improves the functional recovery. There was no significant correlation between slight difference of the early reduction grades within 5mm of acute acromioclavicular dislocations and shoulder functional outcomes according to the Karlsson evaluation criteria in the last follow-up. Orthopedists should pay more attention to the complication of clavicular osteolysis and reduction loss at follow-ups
KEY WORDS  acromioclavicular dislocation  TightRope  minimally invasive  a tiny incision over the coracoid-base  clavicular osteolysis
 
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