肩关节镜下喙锁韧带重建术与切开改良Weaver-Dunn手术治疗肩锁关节脱位的疗效比较

Arthroscopic coracoclavicular ligament reconstruction versus open modified Weaver-Dunn procedure for acromioclavicular joint dislocations: comparison of curative effect

目的：对比采用肩关节镜下喙锁韧带重建术与改良Weaver-Dunn术治疗肩锁关节脱位的临床疗效。方法：回顾性选取2011年1月至2012年6月连续收治并获得随访的63例肩锁关节脱位患者的临床资料，其中男性49例，女性14例，平均年龄（40．3±10．6）岁，受伤到手术时间平均为（10．3±5．3） d。根据Rockwood分型，其中RockwoodⅤ型肩锁关节脱位患者45例，RockwoodⅢ型并高运动水平需求患者18例。根据手术方式不同将患者分为关节镜手术组（32例）和切开手术组（31例）。术后定期随访，采用疼痛视觉模拟评分（ visual analogue score， VAS）、美国肩肘外科医师评分（ American shoulder and elbow surgeons， ASES）及加州大学洛杉矶分校评分（ University of California Los Angeles， UCLA）评价患者肩关节功能状况；同时拍摄双肩关节正位X线片，评估是否有肩锁关节复位丢失。结果：63例患者术后平均随访（29．6±6．0）个月（24～43个月）。关节镜手术组和切开手术组患者年龄[（41．0±10．5）岁vs．（38．0±10．8）岁）]、性别（男／女，24／8 vs．25／6）、损伤类型（Ⅴ／Ⅲ，22／10 vs．23／8）、受伤至手术时间[（10．6±4．9） d vs．（10．1±5．7） d]、主力侧累及情况（19／32 vs．17／31）、平均随访时间[（29．8±6．4）月vs．（29．5±5．5）月]差异均无统计学意义（P＞0．05）。末次随访时，两组患者肩关节平均前屈上举[（164．4°±17．2°） vs．（162．6°±12．9°）]、体侧外旋[（60．9°±17．0°） vs．（57．3°±15．8°）]及内旋[（第12胸椎体水平±3个椎体） vs．（第12胸椎体水平±3个椎体）]、平均ASES评分（96．0±5．1 vs．94．5±3．8）及UCLA评分（34．2±1．5 vs．33．7±1．4）差异均无统计学意义（P＞0．05）。关节镜手术组复位丢失率（1／32）低于切开手术组（7／31，P＝0．026）。结论：采用肩关节镜下喙锁韧带重建术或改良Weaver-Dunn术治疗肩锁关节脱位，术后均可获得良好的肩关节功能，并且肩关节功能差异无统计学意义；关节镜手术组术后复位丢失率低于切开手术组。

Objective：To compare the surgical outcomes between arthroscopic coracoclavicular ligament reconstruction and open modified Weaver-Dunn procedure for the treatment of acromioclavicular joint dis-locations.Methods：From January 2011 to June 2012, 63 consecutive patients with acromioclavicular joint dislocations who were treated with either arthroscopic coracoclavicular ligament reconstruction or open modified Weaver-Dunn procedure were retrospectively reviewed after the final follow-up.There were 49 men and 14 women with a mean age of （40.3 ±10.6） years.The mean time from injury to surgery was （10.3 ±5.3） d.According to the Rockwood classification, there were 45 patients with type V injury and 18 patients with typeⅢinjury.All the patients with typeⅢinjury claimed high level of sport activi-ty.The patients were divided into the arthroscopic surgery group （32 cases） or the open surgery group （31 cases） depending on the type of the surgery that each patient had taken.All the patients were rou-tinely followed up after the surgery.The visual analogue score （ VAS ） , American shoulder and elbow surgeons（ ASES） score and University of California Los Angeles（ UCLA） score were employed to evaluate the postoperative shoulder function.The postoperative radiographs of both shoulders were taken for each patient to evaluate the loss of reduction of the acromioclavicular joint.Re sults：The mean follow-up time was （29.6 ±6.0） months （ range：24 to 43 months） .No significant difference was found between the arthroscopic surgery group and the open surgery group with regard to the patient’ s age [（41.0 ±10.5） years vs.（38.0 ±10.8） years], gender （male/female,24/8 vs.25/6）, classification （Ⅴ/Ⅲ,22/10 vs. 23/8）, time from injury to surgery [（10.6 ±4.9） d vs.（10.1 ±5.7） d], dominant involvement （19/32 vs.17/31）and mean follow-up time [（29.8 ±6.4） months vs.（29.5 ±5.5） months], P〉0.05.At the end of the last follow-up, no significant difference was noted between the two groups regarding the mean forward elevation [（164.4 ±17.2） degrees vs.（162.6 ±12.9） degrees], mean external rotation [（60.9 ±17.0） degrees vs.（57.3 ±15.8） degrees], mean internal rotation [（T12 ±3 vertebrae） vs. （T12 ±3 vertebrae）], mean ASES scores （96.0 ±5.1 vs.94.5 ±3.8）and UCLA scores （34.2 ±1.5 vs. 33.7 ±1.4）, P〉0.05.The rate of loss of reduction was significantly lower in the arthroscopic surgery group （1/32） compared with the open surgery group （7/31, P=0.026）.Conclusion：Surgical treatment for acromioclavicular joint dislocations with either arthroscopic reconstruction or open modified Weaver-Dunn procedure could yield good results with no significant difference between the two groups as for the postoperative shoulder function.The rate of loss of reduction was lower in the arthroscopic surgery group compared with that of the open surgery group.