目的：比较应用纽扣钢板与带袢钢板两种内固定方法治疗新鲜Rockwood Ⅲ型以上肩锁关节脱位的临床疗效。方法选取60例Rockwood Ⅲ型以上肩锁关节脱位患者，均为新鲜单纯肩锁关节脱位，不合并肩关节周围其他损伤。按单、双号分为纽扣钢板组(A组)和带绊钢板组(B组)，每组30例。记录两组的切口长度、手术时间、术中出血量；采用Constant评分评价两组术前、术后6个月后的患肩功能；术后第3天及术后6个月测定喙锁距离分析复位丢失量。结果患者均获得随访，时间7~24个月。两组切口长度比较差异无统计学意义(P>0．05)。手术时间、术中出血量A组均少于B组，差异均有统计学意义(P<0．05)。术后6个月 Constant 评分两组与术前比较差异均有统计学意义(P<0．05)，两组间比较差异无统计学意义(P>0．05)。术后复位丢失量两组比较差异无统计学意义( P>0．05)。结论应用纽扣钢板内固定治疗肩锁关节脱位复位丢失较小，固定安全、可靠，是治疗Rockwood Ⅲ型以上肩锁关节脱位较为理想的方法。%Objective To compare curative effect of the improved Endobutton and the ordinary Endobutton internal fixation surgery in the treatment of the Rockwood type Ⅲ acromioclavicular joint dislocation. Methods 60 patients with Rockwood type Ⅲ acromioclavicular joint dislocation were selected. The study only included the fresh acromio-clavicular joint dislocation, not about the damage around acromioclavicular joint. All the patients were divided into group A or B according to odd and even numbers, and each group had 30 patients. The improved Endobutton was group A and the ordinary Endobutton was group B. Average length of the incision, operation time and blood loss were recorded. The Constant score was adopted to evaluate shoulder joint function between preoperation and 6 months of postoperation. Loss of reduction was evaluated by the change of distance between coracoid and clavicle in the third day and 6 months after operation. Results 60 patients had been followed up from 7 months to 24 months, and the differences of incision average length comparison between two groups were not significant (P>0. 05). The operation time and blood loss in group A were less than group B, and the differences were statistically significant (P<0. 05). The Constant score comparison after 6 months were statistically different from preoperation ( P <0. 05 ) , and the difference between group A and B were not statistically significant ( P>0. 05 ) . There was no significant difference between the two groups in the amount of average reduction loss (P>0. 05). Conclusions The treatment of acromio-clavicular joint dislocation with improved Endobutton is safe and reliable. It is an ideal method to treat the Rockwood type Ⅲ acromioclavicular joint dislocation, and it is worth being recommended for a wider use.
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