三重固定纽扣钢板解剖重建陈旧性Ⅲ度肩锁关节脱位

TRIPLE ENDOBUTTON TECHNIQUE FOR REPAIR OF CHRONIC COMPLETE ACROMIOCLAVICULAR JOINT DISLOCATIONS

目的探讨三重固定纽扣钢板解剖重建喙锁韧带治疗陈旧性Ⅲ度肩锁关节脱位的手术方法及临床疗效。方法 2009年1月-2010年6月,对14例陈旧性Ⅲ度肩锁关节脱位行三重固定纽扣钢板解剖重建喙锁韧带治疗。男10例,女4例;年龄26～52岁,平均38.5岁。致伤原因:交通事故伤7例,摔伤5例,砸伤2例。左侧9例,右侧5例。受伤至手术时间29～75 d,平均49d。肩锁关节有不同程度压痛,关节主、被动活动明显受限,X线片示肩锁关节完全脱位。按Allman分型标准,均为Ⅲ度完全性脱位。结果术后切口均Ⅰ期愈合,无血管、神经损伤及感染等早期并发症发生。患者均获随访,随访时间13～30个月,平均18.3个月。术后1周1例患者发生复位部分丢失,X线片检查见肩锁关节半脱位,未给予特殊处理,其余患者无再脱位或其他相关并发症发生。末次随访时,根据美国肩肘外科协会(ASES)评分标准,获(90.8±4.1)分,与术前的(65.3±4.4)分比较,差异有统计学意义(t=-17.57,P=0.00);Constant-Murley评分为(91.7±3.9)分,与术前的(71.5±4.6)分比较,差异有统计学意义(t=-75.02,P=0.00)。简明肩关节功能测试问卷(SST)的肯定答案为7～12个,平均9.7个。结论三重固定纽扣钢板解剖重建喙锁韧带可有效治疗陈旧性Ⅲ度肩锁关节脱位,早期疗效满意。

Objective To evaluate the early result of triple Endobutton technique for reconstructing coracoclavicular l igament of chronic complete acromioclavicaular joint dislocations. Methods Between January 2009 and June 2010, 14 patients with chronic complete acromioclavicaular joint dislocations were treated with tri ple endobutton technique for reconstructing coracoclavicular l igament. There were 10 males and 4 females with a mean age of 38.5 years （range,26-52 years）. Injury was caused by traffic accident in 7 cases,by fall ing in 5 cases,and by briuse in 2 cases. The average time was 47 days from injury to the operation （range,29-75 days）. All patients had pain and activity restriction. The X-ray films showed complete dislocation of acromioclavicular joint.According to Allman’s type, all cases were classified as III degree complete dislocations. Results At postoperation, wound healed by first intention with no early compl ication of infection. All patients were followed up 18.3 months on average （range,13-30 months）. Acromioclavicular joint subluxation occurred in 1 patient at 1 week after operation, and no redislocation or other compl ication occurred in the other patients. American Shoulder and Elbow Surgeons ASES score was （91.7 ± 3.9） at last follow-up, showing significant difference when compared with the preoperative score （71.5 ± 4.67） （t= — 17.57,P=0.00）; Constant-Murley score was （90.8 ± 4.1）, showing significant difference when compared with preoperative one （65.3 ± 4.4） （t= — 75.02,P=0.00）. The definite answer in Simple Shoulder Test （SST） averaged 9.7 （range,7-12）. Conclusion The tri ple Endobutton technique for reconstructing coracoclavicular l igament is an effective method in treatment of chronic complete acromioclavicaular joint dislocations. The short-term results are satisfactory.