CAJ | 학술논문

目的比较改良Dewar法和关节镜下双钮扣钢板固定法治疗新鲜Rockwood Ⅲ~Ⅴ型肩锁关节脱位的临床疗效.方法 1997年10月至2009年10月间卫生部北京医院骨科收治的新鲜Rockwood Ⅲ~Ⅴ型肩锁关节脱位患者中,随访到改良Dewar法28例,男20例,女8例,年龄18～68岁,平均随访6.8年;全关节镜下双钮扣钢板固定法24例,男19例,女5例,年龄19～65岁,平均随访1.5年.分别对两组患者术后的影像学结果、临床疗效及并发症进行对比分析.结果改良Dewar组和双钮扣钢板组的优良率分别为92.8%和95.8%,两组间优良率、VAS(视觉模拟疼痛评分)和UCLA(美国加州大学洛杉矶分校)功能评分差异均无统计学意义.改良Dewar组喙锁韧带异位骨化发生率较关节镜下双钮扣钢板固定组高,分别为25%和8.33%,但差异无统计学意义.改良Dewar组喙锁间距较双钮扣钢板组大,分别为11.96 mm和8.54 mm(P<0.05).结论关节镜下双钮扣钢板固定法和改良Dewar法均是治疗新鲜Rockwood Ⅲ～Ⅴ型肩锁关节脱位的有效方法,全关节镜下双钮扣钢板固定法与改良Dewar法相比,创伤较小,术后可以更好的维持喙锁关系.
목적 비교개량Dewar법화관절경하쌍뉴구강판고정법치료신선Rockwood Ⅲ~Ⅴ형견쇄관절탈위적림상료효.방법 1997년10월지2009년10월간위생부북경의원골과수치적신선Rockwood Ⅲ~Ⅴ형견쇄관절탈위환자중,수방도개량Dewar법28례,남20례,녀8례,년령18～68세,평균수방6.8년;전관절경하쌍뉴구강판고정법24례,남19례,녀5례,년령19～65세,평균수방1.5년.분별대량조환자술후적영상학결과、림상료효급병발증진행대비분석.결과 개량Dewar조화쌍뉴구강판조적우량솔분별위92.8%화95.8%,량조간우량솔、VAS(시각모의동통평분)화UCLA(미국가주대학락삼기분교)공능평분차이균무통계학의의.개량Dewar조훼쇄인대이위골화발생솔교관절경하쌍뉴구강판고정조고,분별위25%화8.33%,단차이무통계학의의.개량Dewar조훼쇄간거교쌍뉴구강판조대,분별위11.96 mm화8.54 mm(P<0.05).결론 관절경하쌍뉴구강판고정법화개량Dewar법균시치료신선Rockwood Ⅲ～Ⅴ형견쇄관절탈위적유효방법,전관절경하쌍뉴구강판고정법여개량Dewar법상비,창상교소,술후가이경호적유지훼쇄관계.
Objective To compare the clinical outcomes of modified Dewar method versus arthroscopic double Endobutton fixation technique for the treatment of acute acromioclavicular joint dislocation (Rockwood types Ⅲ-Ⅴ).Methods All cases with acute acromioclavicular joint dislocation (Rockwood types Ⅲ-Ⅴ) were treated at our department from October 1997 to October 2009.Among them, 28 cases undergoing modified Dewar method were followed up.There were 20 males and 8 females aged 18-68 years old with a mean follow-up period of 6.8 years.And the arthroscopic technique of Endobutton fixation was employed for another 24 cases.There were 19 males and 5 females aged 19-65 years old with a mean follow-up period of 1.5 years.The radiographic findings, clinical outcomes and complications of two groups were compared.Results The good/excellent rate of modified Dewar group and arthroscopic double Endobutton group were 92.8% and 95.8% respectively.There was no significant difference between two groups.No significant difference existed between two groups as to the VAS (visual analogue scale) pain score and UCLA (University of California at Los Angeles) score.The modified Dewar group had a higher rate of ectopic ossification in coracoclavicular ligament than that of the arthroscopic double Endobutton group (25% vs 8.33%).Yet there was no statistical significance.However, the distance between clavicle and coracoid process was larger in the modified Dewar group (11.96 vs 8.54 mm, P<0.05).Conclusion Both modified Dewar method and arthroscopic double Endobutton fixation technique are both efficient therapies for acute acromioclavicular dislocation (Rockwood types Ⅲ-Ⅴ). The former tends to be more invasive while the latter can better maintain the relationship of corocoid process and clavicle.