生物性韧带修复术治疗新鲜肩锁关节完全脱位

Biological repair of ligaments for acromioclavicular dislocation

目的研究通过生物性韧带修复的新型手术方法治疗肩锁关节完全脱位。方法根据肩部解剖生理和生物力学设计手术，对肩锁关节全脱位即Ⅲ度损伤的患者用生物可吸收缝合线或粗丝线经骨穿孔延纤维走向修复喙锁韧带以重建肩锁关节垂直方向的稳定；再用双圈缝合法修复肩锁韧带和关节囊以重建肩锁关节水平方向的稳定。手术简便、创伤小，不影响关节面，不使用金属内固定材料，可达到肩锁关节的坚强固定。结果 11例患者术后随访 1～ 2.5年，肩关节活动度恢复正常，内固定稳定，无缝线松脱断裂，愈合良好，无明显并发症，避免了金属内固定的二次拆除手术，全部病例疗效达到 Karlsson A级。结论应用生物可吸收缝线或丝线，按生物力学原理重建喙锁韧带及肩锁韧带治疗肩锁关节脱位疗效可靠。

Objective An innovation of operative procedure with biological repair of ligaments for the treatment of acromioclavicular dislocation. Methods Based on the anatomy, physiology, and biomechanics, the operation was designed for restoring the stability of a completely dislocated acromioclavicular joint. Through bone holes drilled along the direction of coracoclavicular ligament fibers, the synthetic absorbable suture was used to rebuild the coracoclavicular ligament for vertical stability of the joint, and then a double- loop suture was performed to rebuild acromioclavicular ligament and the capsule for horizontal stability. This biomechanical repair was simple, rapid procedure, and of less tissue trauma. The acromioclavicular joint was steadily fixed without any metallic imbedding, nor interference with joint surface. Results With 1－ 2.5 years follow- up, 11 patients recovered with good healing, normal range of shoulder joint motion, and stable fixation. There was no need for secondary procedure to remove the sutures. The curative results of all patients were A degree based on the Karlsson’ s evaluation. There was no any complication. Conclusion The synthetic absorbable suture could be used with satisfaction for the repair of acromioclavicular dislocation. Compared with routine fixation with metallic material, the new kind of biofixation was not only effective, but also avoided the need of a second procedure for suture removal.