The Comparison Of Clinical Outcomes Between Arthroscopic Endobutton Plate Double Bands Reconstruction Of Coracoclavicular Ligament And Clavicular Hook Plate Internal Fixation In Treating Rockwood Ⅴ Acromioclavicular Dislocation

Objective: We compared short term clinical outcomes between arthroscopic Endobutton plate double bands reconstruction of coracoclavicular ligament and calvicular hook plate internal fixation in treating Rockwood Ⅴ acromioclavicular dislocation.Providing clinical practice for surgical way of treating acromioclavicular dislocation.Methods: We retrospectively analyzed 43 patients with Rockwood Ⅴacromioclavicular dislocation admitted to the department of orthopedics at The Second Affiliated Hospital of Dalian Medical University from 2012~01 to 2016~01.We assigned these patients into two groups and retrospectively analyzed their data.The experiment group: 20 patients,arthroscopic Endubutton plate double bands reconstruction of coracoclavicular ligament,male 16,female 4,right shoulder 8,left shoulder 12,average age 40.00±14.19.The contrasted group:23 patients under clavicular hook plate internal fixation,male 20,female 3,right shoulder 11,left shoulder 12,average age 41.43±14.01.Shoulder functional scale Constant-Murley and VAS pain score were all implemented preoperatively.X-ray and CT were all arranged to shoulder joint to all patients,we used MRI to exclude diseases like rotator cuff injury,frozen shoulder and glenoid labrum injury,etc.All patients were injured within 1 week.4 weeks of shoulder and elbow condole belt fixation were given to all patients postoperatively,and postoperative functional rehabilitation program was encouraged toall patients.We compared preoperative Constant score and VAS pain score,surgical time,blood loss and postoperative Constant score,VAS pain score and X-ray respectively during 1st month,3rd month,6th month,12 th month.Clavicular hook plates were all taken out on 6th month postoperatively in contrasted group,and all evaluation scales were taken before that.We compared clinical outcomes of these two groups in all stages.T-test was implemented to the comparisons of both experimented and contrasted groups relating to surgical duration,blood loss and preoperative or postoperative scale evaluation at all stages,test standard α=0.05.Results: Surgeries were successfully performed to all 43 patients,dislocations were all anatomically recovered in X-ray postoperative day 2.All patients were fully followed up,and with Ⅰ grade healing wound.Experiment group: average surgical time(119.25±8.32)min,contrasted group: average surgical time(43.91±4.84)min,average blood loss in experiment group(63.00±7.85)ml,and average blood loss in contrasted group(82.17±6.18)ml,c-arm was used in contrasted group and not used in experiment group.The operative Constant score of experiment group and contrasted group were 23.80±5.06,24.61±4.84,respectively,the operative VAS pain score of experiment group and contrasted group were 6.15±1.09,6.13±1.27,respectively.It showed that preoperative scales between two groups,with no statistical significance(P> 0.05).Postoperative 1st month Constant score of experiment group and contrasted group were 85.45±3.65,78.25±3.70,respectively,VAS pain score were 2.00±0.92,3.65±0.86,respectively.Postoperative 3rd month Constant score of experiment group and contrasted group were 89.40±2.54,83.00±2.53,respectively,VAS pain score were1.50±0.69,2.70±0.66,respectively.Postoperative 6th month Constant score of experiment group and contrasted group were 91.70±2.11,87.85±1.42,respectively,VAS pain score were 0.85±0.59,1.90±0.72,respectively.Postoperative 12 th month Constant score of experiment group and contrasted group were 93.45±1.67,93.15±1.73,respectively,VAS pain score were 0.75±0.64,0.95±0.61,respectively.The postoperative Constant score and VAS pain score were much better than preoperativescore,with statistical significance(P<0.05).In postoperative 1st month,3rd month,6th month,Constant score in experiment group were better than contrasted group,with statistical significance(P<0.05),and in postoperative 1st month,3rd month,6th month,VAS pain score in experiment group were also better than contrasted group,with statistical significance(P<0.05).After taking out clavicular hook plates in contrasted group,postoperative 12 th month Constant score and VAS pain score were with no statistical significance(P>0.05).In experiment group,postoperative 1st month,X-ray showed that there was 1 patient with coracoid tunnel cracked,and developed into Rockwood Ⅲ dislocation,the other patients with no tunnel cracked,loosening of the plate and so on.After taking out of the hook plate from contrasted group,2 patients were with dislocation,the other patients were with anatomical relocation.Before the plate was removed,pain was the main complication in contrasted group,and after removing the plate,pain was obvious relieved and scores became much better.In contrasted group there were 6 patients with under acromion bone erosion and accounted26.1%,8 patients with acromioclavicular arthritis and accounted 34.9%.Conclusion: Two surgical ways are both significantly effective in treating acute Rockwood Ⅴ acromioclavicular dislocation.When compared with clavicular hook plate internal fixation way,arthroscopic Endobutton plate double bands reconstruction of coracoclavicular ligament showed significant advantages,it is minimally invasive,anatomically reconstructive,with less complications,high recovery speed of the function,also plate is not necessarily needed to be taken out.Therefore,it is worthwhile to be implemented and widely encouraged in clinic.