肩锁关节脱位Endobutton治疗后失败原因分析

目的分析TossyⅢ型肩锁关节脱位Endobutton治疗后内固定失效的原因，总结失败教训，提高临床疗效。方法回顾本院自2013年至2017年收治的40例TossyⅢ型肩锁关节脱位患者，采用Endobutton带袢钢板内固定治疗，其中，男28例，女12例，平均年龄45.2岁。术后应用Karlsson 进行患肩功能评价。结果所有患者均获得6～18个月随访，平均11.5个月，参照Karlsson 标准评定肩关节功能，其中28例患者术后按Kalsson标准评定恢复属于优，2例患者术后按Kalsson标准评定恢复属于良，优良率75%，其中10例患者术后1～2月内出现内固定失效、肩锁关节再次脱位或肩锁关节复位不佳。结论 Endobutton 带袢钢板治疗TossyⅢ型肩锁关节脱位其操作相对复杂、手术时间及学习曲线均较长,水平方向稳定性欠佳，存在一定的失败率。术中应注意锁骨骨道选取、制备、测量，带袢钢板袢长度的选取及术后正确的功能锻炼这是保证手术疗效的关键。

英文摘要:

Objective To analyze the failure cause of treating acromiodavicular joint dislocation by Endobutton, thereby to improve the clinical efficacy. Methods From Aug 2013 to Sep 2017，40 patients with TossyⅢ acute acromioclavicular joint dislocation were immobilized with Endobutton，including 28 males and 12 females with an average age of 45.2 years. Kalsson grade were used to provide a final evaluation of shoulder function. Results All patients were followed up for a range of 6～18 months (average 11.5 months). According to Karlsson scoring, the results were excellent in 28 cases, goog in 2 cases, the excellent and good rate was 75% (30/40), 10 patients had internal fixation failure, dislocation of the acromioclavicular joint or poor shoulder acromioclavicular joint within 1～2 months after operation. Conclusion Endobutton for the treatment of TossyⅢ acromioclavicular joint dislocation is effective approach. However, its operation is relatively complicated, the operation time and learning curve are long, and the stability in the horizontal direction is not good. There is still a certain failure rate.It should be noted that the selection, preparation and measurement of the clavicular bone, the selection of the plate length, accurate deposition of the plate and reasonable functional exercise are the key to the curative effect.

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