改良Dewar术治疗完全性肩锁关节脱位

Treatment of Acromioclavicular Dislocation with Transfer of Partial Tendon of Short Head of Biceps

目的探讨改良Dewar术在治疗完全性肩锁关节脱位的临床效果。方法应用改良Dewar术治疗Ⅲ型以上完全性肩锁关节脱位，即切除锁骨外端约1．5～2．0cm，用骨刀凿断喙突的前半外侧1／3部，连同附着于其上的肌腱潜行上移，长度适宜的松质骨螺钉固定在锁骨前方相应位置处，由于联合肌腱的牵引和患臂本身的重力使锁骨自动复位。术后三角巾悬吊患臂4周，4周后患肩功能锻炼。结果本组31肩，手术时问为50～90min，术后患肩X线片示复位成功率100％，随访12—60个月。31例肩关节功能均在术后2～3个月恢复，未发生螺钉脱落断裂和骨块不愈合者，按Karlsson术后疗效评价标准评价结果为：A级（佳）共28例，占90．3％；B级（满意）共3例，占9．7％；C级（差）；茌组无。结论改良Dewar手术通过将锁骨远端切除，形成肩锁之间的假关节，从而避免了肩锁关节退化、导致骨性关节病的发生，减少了肩痛的发生，肩关节活动度影响甚小。凿取带联合肌腱蒂的喙突骨块固定于锁骨可牵引患臂使锁骨自动复位。

Objective To explore the clinical treatment effect of transfer of partial tendon of short head of the biceps on acromioclavicular joint dislocation. Methods A total of 31 cases of fresh acromioclavicular joint dislocation were treated with transfer of partial tendon of short head of the biceps aimed to reconstruct the injured acromioclavicular ligament; a pin was used to fix the dislocated coracoclavicular joint. Results According to the standard of Karlsson scoring, all the cases showed good results and gained satisfactory function in 12 - 60 months＇ follow-up. Conclusion The transfer of partial tendon of short head of the biceps is a good choice to treat the acromioclavicular joint dislocation with its high stress resistance, excellent blood supply, etc.