Ⅲ型肩锁关节脱位115例手术治疗体会

The surgical treatment of acromioclavicular three-grade dislocation:Report of 115 cases

目的 评估四种手术方法治疗肩锁关节脱位的疗效, 探讨如何改进手术技巧以提高手术疗效。方法 采用双克氏针钢丝张力带固定、Dewar手术、锁骨钩钢板内固定、阔筋膜肌腱和碳纤维捆绑带修复重建喙锁韧带四种方法治疗AllmanⅢ型肩锁关节脱位患者共120例; 其中有5例出现术中并发症。结果 115例获得随访, 平均随访时间4年1个月, 根据Karlsson的疗效标准: 双克氏针钢丝张力带固定组优良率75 6%, Dewar手术组优良率93 9%, 锁骨钩钢板内固定组优良率96 7%, 自体肌腱和碳纤维捆绑带固定组优良率85 7%, 术后有14例出现并发症。结论 锁骨钩钢板内固定和Dewar术式是治疗肩锁关节脱位的较好选择, 手术要根据病例选择合适的术式, 还要注意术中的操作技巧和良好的术后管理。

Objective To evaluate the clinical result of four surgical treatment of acromioclavicular dislocation,and advancing manipulative skill to improve the effect of surgical therapy.Methods One hundred and twenty patients with Allman type Ⅲ acromioclavicular dislocation were treated with tension band wiring,Dewars procedure,Wolter plate fixation,fascia lata and artificial carbon fiber respectively There were five complication during the operation.Results One hundred and fifteen patients were followed up with an average period of four years and one month.Acording to Karlssons standards,the good and fair rate in tension band wiring group was 75 6%,in Dewars procedure group was 93 9%,in Wolter plate fixation group was 96 7%,and in fascia lata and artificial carbon fiber group was 85 7%.There were 14 complication postoperation.Conclusion The methods of Wolter plate fixation and Dewars procedure were better procedure of acromioclavicular dislocation,and the choice of case,manipulative skill during the operation and right postoperative management is also important.