小切口Dewar手术治疗急性肩锁关节脱位临床分析

Small-Incision Dewar's Operation for Acute Acromioclavicular Dislocation

目的探讨小切口Dewar手术治疗急性肩锁关节脱位的临床疗效。方法术中不暴露肩锁关节,将带联合肌腱的喙突骨块上移至锁骨,重建喙锁韧带,静力学固定和动力学复位肩锁关节。结果52例访1～9年,平均4.9年,除1例术后2个月过早取钉导致骨块脱落,其余患者采用Lazzcano疗效评定标准,优44例,良7例。X线片、CT平扫重建、MRI检查均显示肩锁关节面光滑,无硬化、增生、囊性变等骨性关节炎的表现,肩锁关节腔信号均匀。双肩X线片,中立位显示锁骨肩峰端患侧较健侧有所上移,D/W值健侧为0.432±0.101,患侧为0.523±0.083,有显著性差异(t=2.188,P=0.042);持重位D/W值健侧为0.316±0.116,患侧为0.446±0.063,有显著性差异(t=3.111,P=0.006);持重位与中立位差值,健侧为0.116±0.025,患侧为0.087±0.016,无显著性差异(t=1.114,P=0.280)。上举位X线片示肩锁关节间隙良好,无撞击。结论小切口Dewar手术治疗急性肩锁关节完全脱位效果良好,具有创伤小,手术操作及固定简单的优点。

Objective To explore the clinical efficacy of small-incision Dewar＇ s operation for acute acromioclavicular dislocation. Methods Without exposing the a-c joint, the coracoid tip with tendon were transferred to the clavicle to reconstruct the eoracoclavicular ligaments. And then the a-e joint was statically fixed and dynamically replaced. Results A 1- to 9-year follow-up （mean, 4.9 years） was available in 52 patients. According to the Lazzcano Criteria,44 cases had excellent and 7 cases had good results,only one was failed because of bolt prematurity at 2 month after the operation. Roentgenogram, CT, and MRI showed that the surface of the acromioclavieular joint was smooth, no arthritic sign of cirrhosis, hyperplasia, or theca. The signal of the a-e joint was uniform. The Roentgenograms showed that, at the neutrality position, the distal end of the clavicle of the injured side was higher than that of the healthy side. The D/W of the healthy side was 0. 432 ±0. 101, which was significantly higher than that in the injured side （0. 523 ± 0. 083, t = 2.188, P = 0. 042 ）. The difference between the neutrality and hold of the healthy side was 0.116± 0. 025, while that of the injured side was 0. 087 ± 0. 016 （t = 1.114, P = 0. 280）. The Roentgenograms of the raise position showed no impact in the a-c joint. Conclusions Small incision Dewar＇s operation is an effective, safe, and minimally invasive method for the treatment of acute acromioclavicular dislocation.