联合腱外侧半肌腱反转移位重建喙锁韧带治疗肩锁关节脱位

Proximally based conjoined tendon transfer for coracoclavicular ligament recon struction in treatment of acromioclavicular separation

目的介绍应用联合腱反转移位重建喙锁韧带治疗肩锁关节脱位的手术方法,并通过临床病例随访分析其疗效。方法对2001～2003年间经联合腱反转移位重建喙锁韧带治疗的26例RockwoodⅢ～Ⅴ型肩锁关节脱位患者进行随访。最终随访时应用放射学评估肩锁对应情况,并采用ASES评分(AmericanShoulder&ElbowSurgeonsscore)、SST问卷(SimpleShoulderTestForm)和Constant-Murley评分对肩关节功能进行评估。结果术后平均随访22.6个月。所有患者术中锁骨远端的高度均达到解剖复位。最终随访时,26例中21例维持锁骨远端复位。术后平均ASES评分为94.2,疼痛的主观VAS(VisualAnalogScale)评分平均为1.2,肩关节平均前屈上举150°,外旋35°。平均Constant-Murley评分为92.8。SST问卷的肯定答案平均为11个。总体优良率为88.5%(23/26)。当被问及如果健侧肩关节出现相同脱位情况时是否仍愿意接受相同手术治疗时,均得到肯定回答。结论应用联合腱外侧半反转移位重建喙锁韧带并辅助缝合锚固定手术方式,是治疗移位较大的肩锁关节脱位的一种有效方法。联合腱外侧半作为移植物的来源有足够的长度,同时也避免了牺牲喙肩韧带,从而保存了完整的喙肩弓。对于同时合并或以前存在肩袖损伤的患者、以及那些体型较小因而喙肩韧带比较菲薄的患者,以及翻修手术时需要较长移植韧带的情况下,联合腱外侧半可作为一种很好的自体移植韧带来源。

Objective To introduce a procedure, proximally based conjoined tendon transfer, which is to be used for coracoclavicular ligment reconstruction in the treatment of acromioclavicular separation. Methods From 2001 to 2003, 26 patients with acromioclavicular dislocation of Rockwood Grades Ⅲ-Ⅴ were treated with transfer of the lateral half of the conjoined tendon to the distal clavicle in a proximally based fashion with additional coracoclavicular fixation, Radiology was used to evaluate the acromioclavicular correspondence, ASES （American Shoulder ＆ Elbow Surgeon） score, SST （Simple Shoulder Test） form and Constant-Murley score were adopted to evaluate the shoulder functions. Results Follow-ups of 22.6 months on average revealed that the height of distal clavicle reached anatomic reduction in all the cases during operation, At the latest follow-up, the mean ASES score was 94.2, the mean VAS（Visual Analog Scale） score for pain was 1.2, the mean forward flexion was 150°, and the mean external rotation was 35°. The mean Constant-Murley score was 92.8, The number of positive answers to the SST was 11. The overall satisfaction rate was 88.5% （23/26） and all patients replied with “Yes” when questioned with “Do you want to accept the same operation if the same condition happens to your contralateral shoulder？” Conclusions This surgical procedure proves reliable without sacrificing the coracoacromial ligament during coracoclavicular reconstruction. When the patients are complicated with fresh or old rotator cuff injury, or the coracoclavicular ligament is thin, or long ligament is needed in the reconstruction, the proximally based conjoined tendon can be served as a good source of autograft ligament.