金属缝合锚治疗肩锁关节脱位20例

Application of suture anchor to treat acromioclavicular dislocation in 20 cases

背景:肩锁关节脱位由于固定难度大,后期并发症高,临床治疗较为棘手。对于严重肩锁关节脱位的治疗,存在诸多争议。目的:介绍应用锁骨远端切除缝合锚重建喙锁韧带治疗肩锁关节脱位的方法,以及临床病例随访疗效分析。方法:对四川省骨科医院2006-11/2009-01收治的20例肩锁关节脱位患者进行随访,均行锁骨远端切除,缝合锚临时重建喙锁功能,联合腱外1/2转位重建喙锁韧带,可避免肩锁关节炎的发生。最终随访时应用放射学评估,并采用UCLA评分、Constant评分以及肩关节简明测试问卷SST进行肩关节功能评估。结果与结论:重建后随访9～26个月,所有患者术中锁骨远端高度均达到解剖复位。终末随访时,平均UCLA评分为33分,平均Constant评分为91.6分,平均前屈上举146.4°,平均外旋45.6°,肩关节简明测试问卷SST的肯定答案平均为12个,总体优良率为85%(17/20)。缝合锚组织相容性好,生物适应性佳,固定坚固可靠,可确保充分的初期固定;锁骨远端切除预防了肩锁关节炎的发生;联合腱外侧半作为移植物的来源有足够的长度,同时也避免牺牲喙肩韧带,从而保存了完整的喙肩弓。提示应用锁骨远端切除缝合锚重建喙锁韧带治疗肩锁关节脱位,可恢复喙锁韧带维持喙锁间隙的功能,手术时间短,重建后并发症少,无需二次手术,配合重建后功能锻炼,肩关节功能能够恢复至原有水平。

BACKGROUND：Fixation of acromioclavicular dislocation is difficult and often accompanied with complications in late stage in clinic.There are many disputes about treatment of severe acromioclavicular dislocation.OBJECTIVE：To introduce the procedure of distal clavicle excision and reconstruction of coracoclavicular ligament with suture anchor to treat acromioclavicular dislocation and to analyze the effect on clinical cases.METHODS：Twenty cases were followed up from November,2006 to January,2009,diagnosed as acromioclavicular dislocation.Radiological evaluation was applied at final follow up.In addition,shoulder function was measured according to UCLA,Constant Scores and Shoulder Concise Questionnaire（SST）.RESULTS：A mean time of 15.6 months（9-26 months） follow-up was completed after surgery.The height of distal clavicle in all patients reached anatomical reduction.The average UCLA score was 33（28-35）,and the average Constant score was 91.6（82-96）.The average forward flexion and elevation was 146.4,and that of external rotation was 45.6.Positive answers in SST questionnaire were 12 at average.The rate of excellence and good was 85%（17/20） in common.Positive answers were gained,when the same operative treatment was readily accepted if the same fracture arose at contralateral shoulder.Distal clavicle excision and coracoclavicular ligament reconstruction with suture anchor is an effective method to treat acromioclavicular dislocation resulted from severe trauma.Suture anchor has the advantages of good compatibility and adaptation,reliable fixation with high strength in order to obtain stable early fixation.Distal clavicle excision prevents acromioclavicular arthritis.As a choice of allograft,the lateral half of the conjoined tendon not only have enough length,but also prevent the sacrifice of the coracoacromial ligament,so that the complete coracoacromial arch is reserved.For the patient who has co-exiting rotator cuff injury,the lateral half of the conjoined tendon is a good choice of allograft.Reconstruction of coracoclavical ligament with suture anchor,repair of the coracoclavical ligament and restore the function of the coracoclavical space have the advantages of short operation time,less complication and no need of secondary operation.In combination with postoperative rehabilitative exercises,the function of shoulder can reach original sport level.