带袢钢板联合带线锚钉“双束”解剖重建喙锁韧带治疗肩锁关节脱位

Anatomical Double-bundle Reconstruction of Coracoclavicular Ligament for Treating Acromioclavicular Joint Dislocation by Double-Endobutton and TwinFix Technique

目的：评价带袢钢板（Endobutton）联合带线锚钉（TwinFix）技术“双束”解剖重建喙锁韧带治疗RockwoodⅣ-Ⅵ型肩锁关节脱位的临床疗效。方法：回顾性分析2009年4月-2012年12月治疗的RockwoodⅣ—Ⅵ型的肩锁关节脱位72例的患者资料，其中RockwoodⅣ型38例，RockwoodV型18例，RockwoodVI型16例；左侧57例、右侧14例，双侧1例。运用带袢钢板联合带线锚钉技术“双束”解剖重建喙锁韧带。结果：手术时间为40～65min，平均55min；术后摄片提示肩锁关节脱位复位良好；70例患者在术后获得了23～44个月的随访，平均（31．5±9）个月。Constant-Murley肩关节功能评分：术后第1周末分值平均为89．3，术后1年末分值平均为96．4，至术后3年末评分略高于术后1年末的分值，平均为98．1。67例日常活动、工作及运动正常，患肩无不适症状；5例体力劳动及上举患肢时轻度不适。无再脱位、术后肩痛、肩峰撞击等严重并发症发生。结论：采用带袢钢板联合带线锚钉技术“双柬”解剖重建了锥状韧带和斜方韧带，允许患者术后早期功能锻炼，是治疗RockwoodⅣ—Ⅵ型肩锁关节脱位的多平面固定快速恢复生物学稳定性的弹性固定方法。

Objective：To evaluate the curative effect of anatomical double-bundle reconstruction of coracoclavicular ligament on treating rockwood Ⅳ-Ⅵ acromioclavicular joint dislocation with Double-Endobutton plate with cerclage combined with TwinFix suture anchor. Methods： As retrospective analysis, from April 2009 to December 2012,72 patients with Rockwood Ⅳ-Ⅵ acromioclavicular joint dislocation were treated with endobutton plate with cerclage combined with TwinFix suture anchor technique for anatomical double-bundle reconstruction of coracoclavicular ligament, in which there were 38 cases Roekwood type Ⅳ, 18 cases Rockwood V and 16 cases Rockwood Ⅵ ; 57 cases left side , 14 cases right side, 1 case doub-le side . With the use of plate combined with anchor technology ＂double-bundle ＂ anatomical reconstruction of coracoclavic-ular ligament . Results：The operating time was 40-65min, an average of 55 rain. Postoperative X-ray showed that the ac-romioclavicular joint disloeation＇s reset was good. 70 cases undergoing the operation were followed up for 23-44M（average time：30.5±9M）. The Constant-Murley score of shoulder joint ：The average score of constant was 89.3 at the end of the 1st week ,and 96.4 at the end of the first year while 98.1 at the end of the 3rd year ,slightly higher than the first end of the year. 67 patients can do daily activities normally without any symptoms,only 5 patients felled a little unwell when lifting af-fected limb. None occurred dislocation again, nor shoulder pain, postoperative shoulder peak impact and other serious com-plications. Conclusion：Endohutton and TwinFix technology anatomical double-bundle reconstructed the cone ligament and rhombic ligament, so that early postoperative functional exercise was gained. It is a elastic fixation method for treatment of Rockwood Ⅳ-Ⅵ type acromioclavicular joint dislocation as well as multi-plane fixation and quickly recover the biological stability.