带线铆钉治疗TossyⅡ、Ⅲ型肩锁关节脱位

Treatment of Tossy II ＆ IH dislocation of acromioclavicular joint using rivets with thread

目的探讨带线铆钉治疗Tossy Ⅱ、Ⅲ型肩锁关节脱位的疗效。方法2008年1月至2009年2月，治疗Tossy Ⅱ、Ⅲ型肩锁关节脱位患者31例，男19例，女12例；年龄33-49，平均41岁；TossyⅡ型9例，Ⅲ型22例。其中新鲜肩锁关节脱位19例，陈旧性肩锁关节脱位9例，锁骨钩接骨板固定失败3例；患者均不合并骨折。手术均采用Mitek3．0mm带线铆钉植入喙突，以不可吸收尾线穿过锁骨固定脱位，同时修复喙锁韧带或转移喙肩韧带；其中12例采用克氏针辅助固定。采用日本骨科协会（Japanese Orthopaedic Association，JOA）肩关节疾患治疗判定标准和肩锁关节脱位评分系统对术后疗效进行评价。结果31例患者均获得随访，随访时间11-23个月，平均17个月。单纯铆钉固定组术后JOA肩关节疾患评分为65-95分，其中优8例、良9例、可1例、差1例，优良率为89．47％（17／19）；铆钉结合克氏针固定组术后JOA肩关节疾患评分为74-97分，其中优5例、良4例、可3例，优良率为75．00％（9／12）。两组肩锁关节脱位评价系统的优良率分别为94．74％（18／19）和91．67％（11／12）。5例患者在拔除克氏针1～3个月后出现肩锁关节复位部分丢失，但肩关节活动范围较术后无明显变化，未进一步治疗。结论带线铆钉治疗Tossy Ⅱ、Ⅲ型肩锁关节脱位，具有手术创伤小，并发症少，避免二次手术的特点，术后疗效肯定。

Objective To study the treatment effect of rivet with thread, instead of clavicular hook plate, for Tossy Ⅱ＆Ⅲ dislocation of acromioclavicular joint. Methods From January 2008 to February 2009, totally 31 patients with Tossy II or III dislocation of acromioclavicular joint were treated using rivets with thread, including 19 males and 12 females at the age of 33-49 years （mean, 41 years）. Among these patients, 19 suffered fresh acromioclavicular joint dislocation, 9 suffered old acromioclavicular joint dislocation, and 3 did a failed fixation by clavicular hook plate. None of them was combined fracture. Mitek 3.0 mm rivet with thread was embedded to coracoid, with nonabsorbable thread connected with the rivet passing through the clavicle for fixation, and meanwhile ligament coracoclaviculare was restored or acromiocoracoid ligament displaced. Among them, 12 patients assisted Kieschner wire fixation. The treatment effect was evaluated using Japanese Orthopaedic Association （JOA） scoring system and acromioclavicular joint dislocation scoring system. Results All patients were followed up 11-23 months （mean, 17 months）. In the patients without Kieschner wire fixation, JOA shoulder score was 65-95, excellent for 8 cases, good for 9, fine for l, poor for I, excellent and good rate was 89.47% （17/19）;In the patients with Kieschner wire assisted fixation, JOA shoulder score was 74-97, excellent for 5, good for 4, fine for 3; the excellent and good rate was 75.00% （9/12）. With acromioclavicular joint dislocation scoring system, the overall excellent and good rate was 94.74% （18/19）, and 91.67% （11/12） respectively. No complication that affected joint function was found. Conclusion Rivets with thread can be used for treating Tossy Ⅱ＆Ⅲ dislocation of acromioclavicular joint. This surgical technique is characterized by small operation wound, fewer complications, no secondary operation, and satisfactory treatment effect.