目的:急性肩锁关节脱位是一种常见的骨科损伤,可明显损害肩关节功能并降低生活质量。有效的治疗方法对于恢复功能和减轻疼痛至关重要。探讨骨科手术机器人定位系统(TiRobot)辅助下微创闭环双腔内固定治疗AC关节脱位的近期临床疗效。并评价其可行性和安全性。
方法:回顾性分析2020年5月至2022年12月行TiRobot双Endobutton闭环内固定治疗的19例AC关节脱位患者的临床资料。视觉模拟量表(VAS)疼痛评分,恒定的Murley分数(CMS),术前和末次随访时评估和比较肩关节外展活动范围。肩锁关节的计算机断层扫描(CT)参数,包括肩锁距离(ACD),上、下Endobutton(DED)之间的距离,锁骨远端前缘与肩峰前缘之间的水平距离(DACC),锁骨隧道(DCT)的直径,和喙突隧道直径(DC),在2天比较,手术后1个月,以及在最后的后续行动中,以及术中和术后并发症的评估。
结果:术后VAS,CMS,与术前相比,肩外展活动范围显着改善(所有,P<0.05)。统计学分析显示术后2天和1个月肩锁关节CT图像参数无显著差异(均,P>0.05)。DCT和DC比较,末次随访与术后1个月比较差异有统计学意义(P<0.05)。在ACD中没有发现统计学上的显著差异,DED,和DACC(所有,P>0.05)。没有感染或血管或神经损伤等并发症,没有头骨或锁骨骨折的病例,减少的损失,异位骨化,肩部刚度,内部固定没有松动或断裂。
结论:TiRobot辅助下的闭环双神经内固定是治疗急性肩锁关节脱位的理想方法。该方法具有操作相对简单的优点,在手术中更准确地定位骨隧道,手术创伤较小,良好的肩部功能恢复。
OBJECTIVE: Acute acromioclavicular (AC) joint dislocation is a common orthopedic injury that can significantly impair shoulder function and reduce quality of life. Effective treatment methods are essential to restore function and alleviate pain. To investigate the short-term clinical efficacy of the minimally invasive closed-loop double endobutton fixation assisted by orthopaedic surgery robot positioning system (TiRobot) in the treatment of AC joint dislocation, and to evaluate its feasibility and safety.
METHODS: The clinical data of 19 patients with AC joint dislocation who underwent treatment with closed-loop double Endobutton fixation assisted by TiRobot between May 2020 and December 2022 were retrospectively analyzed. Visual Analog Scale (VAS) pain scores, the Constant Murley Score (CMS), and shoulder abduction range of motion were assessed and compared preoperatively and at the last follow-up. Computed tomography (CT) parameters of the acromioclavicular joint, including acromioclavicular distance (ACD), the distance between the upper and lower Endobutton (DED), the horizontal distance between the anterior edge of the distal clavicle and the anterior edge of the acromion (DACC), the diameter of the clavicular tunnel (DCT), and coracoid tunnel diameter (DC), were compared at 2 days, and 1 month after surgery, as well as at the last follow-up, along with the evaluation of intraoperative and postoperative complications.
RESULTS: The postoperative VAS, CMS, and shoulder-abduction range of motion were significantly improved compared with the preoperative (all, P<0.05). The statistical analysis showed no significant difference in the CT image parameters of the acromioclavicular joint at 2 days and 1 month after surgery(all, P>0.05). Comparisons of DCT and DC revealed statistically significant differences between the last follow-up and 1 month after surgery (P<0.05), and no statistically significant difference was found in ACD, DED, and DACC(all, P>0.05). There were no complications such as infection or vascular or neurological damage, no cases of rostral or clavicle fractures, loss of reduction, heterotopic ossification, shoulder stiffness, and no loosening or breaking of internal fixations.
CONCLUSIONS: Closed-loop double endobutton internal fixation assisted by TiRobot is an ideal method for the treatment of acute acromioclavicular (AC) joint dislocation. This method has the advantages of relatively simple operation, more accurate localization of bone tunnel during operation, less surgical trauma, and good recovery of shoulder function.