关节镜下TightRope固定与锁骨钩钢板固定治疗NeerⅡ型锁骨远端骨折的比较
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摘要
背景:TightRope固定装置已被广泛用于治疗肩锁关节脱位。国外有少量文献报道将其应用到NeerⅡ型锁骨远端骨折,但缺乏其与传统锁骨钩钢板治疗方式的对比研究。目的:观察并比较关节镜下TightRope固定与锁骨钩钢板固定治疗NeerⅡ型锁骨远端骨折的临床疗效。方法:研究对象选自贵州医科大学附属医院2015年10月至2018年2月收治的26例NeerⅡ型锁骨远端骨折的患者。治疗组12例行关节镜下TightRope绊钢板内固定,对照组14例行锁骨钩钢板内固定。比较两组患者自入院至固定后1年内的围术期指标、疼痛评分、肩关节功能评分,影像学结果及不良反应发生情况。结果与结论:TightRope固定组固定后6,12个月的牛津肩关节评分(OSS)、加州大学肩关节等级评分(UCLA)及Constant-Murley肩关节功能评分(CMS)优于锁骨钩钢板组(P <0.05)。TightRope固定组固定后3,6个月的肩关节前屈外展活动范围优于锁骨钩钢板组(P <0.05)。TightRope固定组有1例固定后3个月复查提示有骨折端的愈合欠佳,固定后6个月复查示骨折愈合。锁骨钩钢板组有1例发生骨不连,2例有明显肩部疼痛,1例肩关节外展活动受限,去除内固定后均有缓解。结果显示,关节镜下TightRope固定作为一种微创手术更具优势,损伤小、疼痛轻、功能恢复更好,且不需二次手术取出内固定物,患者满意度高。临床试验方案于2019-05-15通过贵州医科大学附属医院临床试验伦理委员会批准(伦理批准号:2019伦申第226号)。
BACKGROUND: TightRope device has been widely used for acromioclavicular dislocation. Outside China, a few studies have reported that TightRope device is used for Neer type ll distal clavicle fractures. However, it is less reported in comparison with the traditional treatment of clavicular hook plate. OBJECTIVE: To observe and compare the clinical results after the arthroscopic treatment using TightRope system and after open repair using clavicular hook plate in Neer type ll distal clavicle fractures. METHODS: Between October 2015 and February 2018, 26 cases of Neer type ll distal clavicle fractures were admitted to this study in the Affiliated Hospital of Guizhou Medical University. In the TightRope system group, 12 cases underwent arthroscopic treatment using TightRope system. In the clavicular hook plate group, 14 cases underwent open repair using clavicular hook plate. From hospitalization to 1 year after surgery, the perioperative indexes, pain scores, shoulder function scores, radiologic outcomes and complications were collected and compared between the two groups. RESULTS AND CONCLUSION: The scores of the Oxford Shoulder Score, University of California at Los Angeles, and Constant-Murley Score were better in the TightRope system group than those in the clavicular hook plate group at 6 and 12 months postoperatively(P < 0.05). The range of forward flexion and abduction motion of the shoulder was significantly better in the TightRope system group than in the clavicular hook plate group at 3 and 6 months postoperatively(P < 0.05). One patient in the TightRope system group showed a poor healing of the fracture ends 3 months postoperatively. At 6 months postoperatively, the fracture was healed well. In the clavicular hook plate group, one elderly patient had nonunion; two patients had significant shoulder pain; and one patient had limited shoulder abduction. These complications alleviated gradually after removing the hook plate. These results demonstrated that the arthroscopic treatment using TightRope system is a minimally invasive surgical procedure, and characterized by minor wound, light pain, good functional recovery, and not requiring secondary surgery to remove internal implant, and high patient satisfaction. This study was approved by the Clinical Trial Ethics Committee, the Affiliated Hospital of Guizhou Medical University on May 15, 2019(approval number: 2019 LS226).
BACKGROUND: TightRope device has been widely used for acromioclavicular dislocation. Outside China, a few studies have reported that TightRope device is used for Neer type ll distal clavicle fractures. However, it is less reported in comparison with the traditional treatment of clavicular hook plate. OBJECTIVE: To observe and compare the clinical results after the arthroscopic treatment using TightRope system and after open repair using clavicular hook plate in Neer type ll distal clavicle fractures. METHODS: Between October 2015 and February 2018, 26 cases of Neer type ll distal clavicle fractures were admitted to this study in the Affiliated Hospital of Guizhou Medical University. In the TightRope system group, 12 cases underwent arthroscopic treatment using TightRope system. In the clavicular hook plate group, 14 cases underwent open repair using clavicular hook plate. From hospitalization to 1 year after surgery, the perioperative indexes, pain scores, shoulder function scores, radiologic outcomes and complications were collected and compared between the two groups. RESULTS AND CONCLUSION: The scores of the Oxford Shoulder Score, University of California at Los Angeles, and Constant-Murley Score were better in the TightRope system group than those in the clavicular hook plate group at 6 and 12 months postoperatively(P < 0.05). The range of forward flexion and abduction motion of the shoulder was significantly better in the TightRope system group than in the clavicular hook plate group at 3 and 6 months postoperatively(P < 0.05). One patient in the TightRope system group showed a poor healing of the fracture ends 3 months postoperatively. At 6 months postoperatively, the fracture was healed well. In the clavicular hook plate group, one elderly patient had nonunion; two patients had significant shoulder pain; and one patient had limited shoulder abduction. These complications alleviated gradually after removing the hook plate. These results demonstrated that the arthroscopic treatment using TightRope system is a minimally invasive surgical procedure, and characterized by minor wound, light pain, good functional recovery, and not requiring secondary surgery to remove internal implant, and high patient satisfaction. This study was approved by the Clinical Trial Ethics Committee, the Affiliated Hospital of Guizhou Medical University on May 15, 2019(approval number: 2019 LS226).
引文
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[2]Oh JH,Kim SH,Lee JH,et al.Treatment of distal clavicle fracture:a systematic review of treatment modalities in 425fractures.Arch Orthop Trauma Surg.2011;131(4):525-533.
[3]Takase K,Kono R,Yamamoto K.Arthroscopic stabilization for Neer type 2 fracture of the distal clavicle fracture.Arch Orthop Trauma Surg.2012;132(3):399-403.
[4]Motta P,Bruno L,Maderni A,et al.Acute lateral dislocated clavicular fractures:arthroscopic stabilization with TightRope.JShoulder Elbow Surg.2014;23(3):e47-e52.
[5]陈建海,党育,付中国,等.关节镜下纽扣钢板固定术治疗不稳定锁骨远端骨折[J].中华肩肘外科电子杂志,2015,3(3):133-140.
[6]NEER CS 2nd.Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults.J Trauma.1963;3:99-110.
[7]Preedy VR,Watson RR.Visual Analogue Scale.Handbook of Disease Burdens and Quality of Life Measures.New York:Springer,USA.2010:4349-4349.
[8]Dawson J,Fitzpatrick R,Carr A.Questionnaire on the perceptions of patients about shoulder surgery.J Bone Joint Surg Br.1996;78(4):593-600.
[9]Ellman H,Hanker G,Bayer M.Repair of the rotator cuff.End-result study of factors influencing reconstruction.J Bone Joint Surg Am.1986;68(8):1136-1144.
[10]Constant CR,Murley AH.A clinical method of functional assessment of the shoulder.Clin Orthop Relat Res.1987;(214):160-164.
[11]王志强,栗树伟,王东.NeerⅡ型锁骨远端骨折的治疗进展[J].中华肩肘外科电子杂志,2017,5(2):138-141.
[12]Li Q,Hsueh PL,Chen YF.Coracoclavicular ligament reconstruction:a systematic review and a biomechanical study of a triple endobutton technique.Medicine(Baltimore).2014;93(28):e193.
[13]Teodoro Ezequiel Guerra M,Isabel Pozzi M,Busin G,et al.Densitometric study of the clavicle:bone mineral density explains the laterality of the fractures.Rev Bras Ortop.2014;49(5):468-472.
[14]汪鹏,董宏然.锁骨远端骨折的治疗进展[J].中国矫形外科志,2014,22(22):2071-2074.
[15]Bishop JY,Jones GL,Lewis B,et al.Intra-and interobserver agreement in the classification and treatment of distal third clavicle fractures.Am J Sports Med.2015;43(4):979-984.
[16]谭虎成,马海涛,毕大卫,等.12例NeerⅡ型锁骨远端骨折内固定失效原因分析[J].中国骨与关节损伤杂志,2014,29(9):940-941.
[17]江涛,苏海涛,朱兴阳,等.NeerⅡ锁骨远端骨折的治疗(英文)[J].中国矫形外科杂志,2014,22(20):1825-1830.
[18]齐双,夏茂盛.锁骨钩钢板和锁骨远端锁定钢板内固定治疗NeerⅡ型锁骨远端骨折术后不良反应和功能恢复的Meta分析[J].中国骨与关节损伤杂志,2016,31(7):715-717.
[19]朱小广,彭庆州,吴宏伟.带线锚钉与锁骨钩板内固定治疗NeerⅡ型锁骨远端骨折的疗效比较[J].中国骨与关节损伤杂志,2016,31(5):535-536.
[20]胡晓川,林辉阳,向明,等.锁定钢板结合缝合锚固定治疗NeerⅡB型锁骨远端骨折[J].中华肩肘外科电子杂志,2015,3(4):199-205.
[21]Seyhan M,Kocaoglu B,Kiyak G,et al.Anatomic locking plate and coracoclavicular stabilization with suture endo-button technique is superior in the treatment of Neer Type II distal clavicle fractures.Eur J Orthop Surg Traumatol.2015;25(5):827-832.
[22]Shin SJ,Ko YW,Lee J,et al.Use of plate fixation without coracoclavicular ligament augmentation for unstable distal clavicle fractures.J Shoulder Elbow Surg.2016;25(6):942-948.
[23]Madsen W,Yaseen Z,LaFrance R,et al.Addition of a suture anchor for coracoclavicular fixation to a superior locking plate improves stability of type IIB distal clavicle fractures.Arthroscopy.2013;29(6):998-1004.
[24]Struhl S,Wolfson TS.Continuous loop double endobutton reconstruction for acromioclavicular joint dislocation.Am JSports Med.2015;43(10):2437-2444.
[25]Dedeo?lu SS,?mren Y,?abuk H,et al.Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures.J Orthop Surg(Hong Kong).2017.
[26]]梁高峰,智丰,张满盈,等.双Endobutton双环套锁内固定术治疗TossyⅢ型肩锁关节脱位及NeerⅡB型锁骨远端骨折[J].中国修复重建外科杂志,2014,28(3):395-396.
[27]Costic RS,Vangura A Jr,Fenwick JA,et al.Viscoelastic behavior and structural properties of the coracoclavicular ligaments.Scand J Med Sci Sports.2003;13(5):305-310.
[28]Soh C,Sivapathasundaram N,Parthiban R,et al.A technique of distal clavicle fracture fixation using the tightrope procedure.Malays Orthop J.2011;5(3):20-23.
[29]Kraus N,Stein V,Gerhardt C,et al.Arthroscopically assisted stabilization of displaced lateral clavicle fractures with coracoclavicular instability.Arch Orthop Trauma Surg.2015;135(9):1283-1290.
[30]Loriaut P,Moreau PE,Dallaudière B,et al.Outcome of arthroscopic treatment for displaced lateral clavicle fractures using a double button device.Knee Surg Sports Traumatol Arthrosc.2015;23(5):1429-1433.
[31]Tischer T,Salzmann GM,El-Azab H,et al.Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V.Am J Sports Med.2009;37(1):136-139.
[32]Cano-Martínez JA,Nicolás-Serrano G,Andrés-Grau J,et al.Treatment of distal-third clavicular fractures(Neer type ii-b)with a triple button device.Rev Esp Cir Ortop Traumatol.2016;60(6):378-386.
[33]Beitzel K,Obopilwe E,Chowaniec DM,et al.Biomechanical comparison of arthroscopic repairs for acromioclavicular joint instability:suture button systems without biological augmentation.Am J Sports Med.2011;39(10):2218-2225.
[34]Salzmann GM,Paul J,Sandmann GH,et al.The coracoidal insertion of the coracoclavicular ligaments:an anatomic study.Am J Sports Med.2008;36(12):2392-2397.
[35]Yi Y,Kim JW.Coronal plane radiographic evaluation of the single TightRope technique in the treatment of acute acromioclavicular joint injury.J Shoulder Elbow Surg.2015;24(10):1582-1587.
[2]Oh JH,Kim SH,Lee JH,et al.Treatment of distal clavicle fracture:a systematic review of treatment modalities in 425fractures.Arch Orthop Trauma Surg.2011;131(4):525-533.
[3]Takase K,Kono R,Yamamoto K.Arthroscopic stabilization for Neer type 2 fracture of the distal clavicle fracture.Arch Orthop Trauma Surg.2012;132(3):399-403.
[4]Motta P,Bruno L,Maderni A,et al.Acute lateral dislocated clavicular fractures:arthroscopic stabilization with TightRope.JShoulder Elbow Surg.2014;23(3):e47-e52.
[5]陈建海,党育,付中国,等.关节镜下纽扣钢板固定术治疗不稳定锁骨远端骨折[J].中华肩肘外科电子杂志,2015,3(3):133-140.
[6]NEER CS 2nd.Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults.J Trauma.1963;3:99-110.
[7]Preedy VR,Watson RR.Visual Analogue Scale.Handbook of Disease Burdens and Quality of Life Measures.New York:Springer,USA.2010:4349-4349.
[8]Dawson J,Fitzpatrick R,Carr A.Questionnaire on the perceptions of patients about shoulder surgery.J Bone Joint Surg Br.1996;78(4):593-600.
[9]Ellman H,Hanker G,Bayer M.Repair of the rotator cuff.End-result study of factors influencing reconstruction.J Bone Joint Surg Am.1986;68(8):1136-1144.
[10]Constant CR,Murley AH.A clinical method of functional assessment of the shoulder.Clin Orthop Relat Res.1987;(214):160-164.
[11]王志强,栗树伟,王东.NeerⅡ型锁骨远端骨折的治疗进展[J].中华肩肘外科电子杂志,2017,5(2):138-141.
[12]Li Q,Hsueh PL,Chen YF.Coracoclavicular ligament reconstruction:a systematic review and a biomechanical study of a triple endobutton technique.Medicine(Baltimore).2014;93(28):e193.
[13]Teodoro Ezequiel Guerra M,Isabel Pozzi M,Busin G,et al.Densitometric study of the clavicle:bone mineral density explains the laterality of the fractures.Rev Bras Ortop.2014;49(5):468-472.
[14]汪鹏,董宏然.锁骨远端骨折的治疗进展[J].中国矫形外科志,2014,22(22):2071-2074.
[15]Bishop JY,Jones GL,Lewis B,et al.Intra-and interobserver agreement in the classification and treatment of distal third clavicle fractures.Am J Sports Med.2015;43(4):979-984.
[16]谭虎成,马海涛,毕大卫,等.12例NeerⅡ型锁骨远端骨折内固定失效原因分析[J].中国骨与关节损伤杂志,2014,29(9):940-941.
[17]江涛,苏海涛,朱兴阳,等.NeerⅡ锁骨远端骨折的治疗(英文)[J].中国矫形外科杂志,2014,22(20):1825-1830.
[18]齐双,夏茂盛.锁骨钩钢板和锁骨远端锁定钢板内固定治疗NeerⅡ型锁骨远端骨折术后不良反应和功能恢复的Meta分析[J].中国骨与关节损伤杂志,2016,31(7):715-717.
[19]朱小广,彭庆州,吴宏伟.带线锚钉与锁骨钩板内固定治疗NeerⅡ型锁骨远端骨折的疗效比较[J].中国骨与关节损伤杂志,2016,31(5):535-536.
[20]胡晓川,林辉阳,向明,等.锁定钢板结合缝合锚固定治疗NeerⅡB型锁骨远端骨折[J].中华肩肘外科电子杂志,2015,3(4):199-205.
[21]Seyhan M,Kocaoglu B,Kiyak G,et al.Anatomic locking plate and coracoclavicular stabilization with suture endo-button technique is superior in the treatment of Neer Type II distal clavicle fractures.Eur J Orthop Surg Traumatol.2015;25(5):827-832.
[22]Shin SJ,Ko YW,Lee J,et al.Use of plate fixation without coracoclavicular ligament augmentation for unstable distal clavicle fractures.J Shoulder Elbow Surg.2016;25(6):942-948.
[23]Madsen W,Yaseen Z,LaFrance R,et al.Addition of a suture anchor for coracoclavicular fixation to a superior locking plate improves stability of type IIB distal clavicle fractures.Arthroscopy.2013;29(6):998-1004.
[24]Struhl S,Wolfson TS.Continuous loop double endobutton reconstruction for acromioclavicular joint dislocation.Am JSports Med.2015;43(10):2437-2444.
[25]Dedeo?lu SS,?mren Y,?abuk H,et al.Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures.J Orthop Surg(Hong Kong).2017.
[26]]梁高峰,智丰,张满盈,等.双Endobutton双环套锁内固定术治疗TossyⅢ型肩锁关节脱位及NeerⅡB型锁骨远端骨折[J].中国修复重建外科杂志,2014,28(3):395-396.
[27]Costic RS,Vangura A Jr,Fenwick JA,et al.Viscoelastic behavior and structural properties of the coracoclavicular ligaments.Scand J Med Sci Sports.2003;13(5):305-310.
[28]Soh C,Sivapathasundaram N,Parthiban R,et al.A technique of distal clavicle fracture fixation using the tightrope procedure.Malays Orthop J.2011;5(3):20-23.
[29]Kraus N,Stein V,Gerhardt C,et al.Arthroscopically assisted stabilization of displaced lateral clavicle fractures with coracoclavicular instability.Arch Orthop Trauma Surg.2015;135(9):1283-1290.
[30]Loriaut P,Moreau PE,Dallaudière B,et al.Outcome of arthroscopic treatment for displaced lateral clavicle fractures using a double button device.Knee Surg Sports Traumatol Arthrosc.2015;23(5):1429-1433.
[31]Tischer T,Salzmann GM,El-Azab H,et al.Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V.Am J Sports Med.2009;37(1):136-139.
[32]Cano-Martínez JA,Nicolás-Serrano G,Andrés-Grau J,et al.Treatment of distal-third clavicular fractures(Neer type ii-b)with a triple button device.Rev Esp Cir Ortop Traumatol.2016;60(6):378-386.
[33]Beitzel K,Obopilwe E,Chowaniec DM,et al.Biomechanical comparison of arthroscopic repairs for acromioclavicular joint instability:suture button systems without biological augmentation.Am J Sports Med.2011;39(10):2218-2225.
[34]Salzmann GM,Paul J,Sandmann GH,et al.The coracoidal insertion of the coracoclavicular ligaments:an anatomic study.Am J Sports Med.2008;36(12):2392-2397.
[35]Yi Y,Kim JW.Coronal plane radiographic evaluation of the single TightRope technique in the treatment of acute acromioclavicular joint injury.J Shoulder Elbow Surg.2015;24(10):1582-1587.