Objective:To discuss the clinical efficacy of the double Endobutton plates technique under the arthroscope to treat the acromioclavicular joint dislocation of Rockwood type Ⅲ or above.Methods:From March 2016 to March 2019, a total of 23 patients with acute acromioclavicular dislocation underwent double Endobutton plates reconstruction of coracoclavicular ligament by arthroscope. Postoperative follow-up was conducted on a regular basis. Visual analogue score of pain (VAS) was used to evaluate shoulder joint pain, the Constant score was used to evaluate shoulder joint function, and the Karlsson score was used to evaluate shoulder joint efficacy. The measurement data within the group were compared by one-way repeated measurement analysis of variance and paired t test.Results:Twenty-three patients were followed up for an average of(13±3)months. No brachial plexus or peripheral vascular injury was found in the patients, and X-ray examination showed anatomic reduction of the acromioclavicular joint in all the patients. The VAS scores were (7.5±0.9), (2.1±0.8), (1.6±0.7) (F=196.25, P<0.001) before operation, and in postoperative six months and 12 months respectively; there were statistically significant differences between the preoperative data and the data of postoperative six and 12 months (all P<0.001). There was no statistically significant difference between the postoperative data of six months and 12 months (t=1.550, P>0.05). The patients′ constant scores were(44.5±3.8), (81.4±3.1), (93.9±2.0)(F=735.25, P< 0.001) before operation, and in the postoperative six months and 12 months respectively; the differences were statistically significant (all P<0.001). At the last follow-up, the Karlsson scores were excellent in 21 cases (91.3%) and good in two cases (8.6%).Conclusion:Arthroscopy assisted double Endobutton plates reconstruction coracoclavicular ligament for Rockwood Ⅲ type above the acromioclavicular joint dislocation has good clinical curative effect, can effectively improve the shoulder joint pain, shoulder joint function recovery.

[目的]对比镜下袢钢板与开放钩钢板固定技术治疗肩锁关节脱位的临床疗效.[方法]回顾性分析本院2016年3月～2019年3月手术治疗的62例肩锁关节脱位患者.其中,镜下袢钢板固定技术(袢钢板组)31例,开放钩钢板固定技术(钩钢板组)31例,比较两组围手术期、随访和影像资料.[结果]袢钢板组切口长度、术中出血量、术后住院时间显著优于钩钢板组(P＜0.05).但两组手术时间的差异无统计学意义(P＞0.05).62例均随访12个月以上,随时间推移,两组患者的VAS评分均显著减少,而Constant评分均显著增加(P＜0.05).术前两组VAS、Constant评分的差异均无统计学意义(P＞0.05).术后6个月、1年袢钢板组VAS、Constant评分均优于钩钢板组(P＜0.05).末次随访时,钩钢板组2例患者术后出现肩峰下撞击痛,活动明显受限,经内固定物取出后好转.与术前相比,术后1年两组患者肩锁关节间隙和喙锁间距均显著减少(P＜0.05).术前及术后1年两组肩锁关节间隙和喙锁间距的差异均无统计学意义(P＞0.05).[结论]与开放钩钢板固定技术相比,镜下袢钢板具有切口小、失血量少、术后疼痛轻等优势,其术后早期肩关节功能恢复更好.

目的:探讨颈椎融合术后邻近节段退变(adjacent segment degeneration,ASD)的相关影响因素.方法:收集2009年1月31日～2011年1月31日在我科行颈椎前路减压植骨融合钢板内固定术治疗的患者,按照纳入和排除标准,共有235例患者纳入本研究,其中男126例,女109例,手术时年龄33 ～70岁,随访时间5～7年.在术前、术后1周以及末次随访时均行颈椎标准正侧位X线片及MRI检查,记录患者的年龄、性别、随访时间、融合节段数等,通过X线片测量并计算术前颈椎管率、手术前后颈椎弧弦距、钢板边缘至手术节段椎体边缘的距离(plate to disc distance,PDD)等影像学指标.根据X线片上Kellgren退变分级法和MRI上Miyazaki椎间盘退变分级法,将患者分为无ASD组和影像学ASD组.采用t检验及x2检验比较两组间各指标的差异,用Logistic回归分析ASD的相关影响因素.结果:末次随访时共有107例患者(45.53％)出现影像学ASD.影像学ASD组患者手术时年龄为39～70岁(53.47±6.33岁),术后弧弦距为0～10.30mm(5.58±2.34mm),上、下PPD均＜5mm 50例,上或下PPD＜5mm 43例,上、下PPD均≥5mm 14例;无ASD组患者年龄为33～61岁(47.56±5.39岁),术后弧弦距0.10～11.21 mm (7.63±2.85mm),上、下PPD均＜5mm 39例,上或下PPD＜5mm 62例,上、下均≥5mm 27例,两组患者手术时年龄、术后弧弦距、PDD差异均有统计学意义(P＜0.05);两组性别比、融合节段数、术前弧弦距、术前与术后弧弦距的差值以及术前颈椎管率均无统计学差异(P＞0.05).Logistic同归分析结果显示手术时年龄、PDD、术后弧弦距与ASD发生率均有显著相关性(P＜0.05).结论:手术时年龄、术后颈椎弧弦距、PDD与颈椎融合术后影像学ASD显著性相关,手术时年龄越大、术后颈椎生理前凸恢复不佳以及PDD＜5mm更容易发生ASD.