应用不同手术方法治疗陈旧性肩锁关节脱位的疗效分析

Review of the results of different operative procedures for old acromioclavicular dislocation

目的比较分析应用不同手术方法治疗陈旧性肩锁关节脱位的疗效。方法对 43例陈旧性肩锁关节脱位患者分别应用单纯切开复位克氏针内固定 (9例 )；切开复位内固定并肩锁关节韧带重建 (14例 )；切开复位内固定并喙突上移 (20例 )三种手术方法进行治疗，术后平均随访 4.8年，对其自觉症状、上肢肌力、肩关节功能和肩锁关节间隙等改善程度进行比较。结果三种术式的优良率分别为 33％ (3/9)、 50％ (7/14)和 74％ (15/20)。单纯切开复位克氏针内固定法的疗效与切开复位内固定并肩锁韧带重建法相比，差异无显著性意义 (P >0.05)，两者与切开复位内固定并喙突上移法比较，差异有显著性意义 (均 P< 0.05)。结论治疗陈旧性肩锁关节脱位的手术方法应达到 :(1)清除关节内瘢痕组织及软骨碎片； (2)重建关节纵向与水平稳定性； (3)施以有效内固定直至韧带修复，牢固愈合。

Objective To compare the results of different operative methods for old acromioclavicular dislocation. Methods Forty- three patients with old acromioclavicular dislocation were treated with three different operative methods: 1)open reduction plus Kirschner wire fixation (9 cases); 2)open reduction plus reconstruction of acromioclavicular ligament (14 cases) and 3)open reduction plus modified Dewar s operation (20 cases). After surgery, the subjective symptoms of the arm, muscular contraction power, function of the shoulder joint and space of acromioclavicular joint in 43 cases were followed- up for an average 4.8 years. Results The excellent results following three operative methods were seen in 33％ , 50％ and 74％ respectively. There was no significant difference between Kirschner wire fixation and reconstruction of acromioclavicular ligament (P > 0.05). Modified Dewar s operation was better compared with Kirschner wire fixation and reconstruction of acromioclavicular ligament (P< 0.05). Conclusion A satisfactory surgical procedure for treatment of old acromioclavicular dislocation should accomplish the following points: removal of scar tissue and intra- articular cartilaginous fragments, reconstruction of joint stability and effective internal fixation until complete healing of the ligament structures.