双Endobutton钢板重建喙锁韧带联合Ⅰ期肩锁韧带修复治疗Ⅲ度以上肩锁关节脱位

Double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament at stage Ⅰ for the treatment of acromioclavicular dislocation with Rockwood type Ⅲ- Ⅴ

目的：探讨双Endobutton钢板联合Ⅰ期肩锁韧带修复治疗Ⅲ度以上肩锁关节脱位的临床疗效。方法：自2010年1月至2013年9月,手术治疗56例RockwoodⅢ度以上肩锁关节脱位的患者,其中男20例,女36例;年龄32~52岁,平均38.5岁;左侧25例,右侧31例;受伤至手术时间3~14 d,平均7 d。术前均诊断为肩锁关节脱位（RockwoodⅢ度以上）,手术采用双Endobutton钢板进行喙锁韧带重建,同时行带线金属骨锚钉修复肩锁韧带。观察患者术后并发症情况,并采用Karlsson评定标准及Constant-Murley评分进行肩关节功能评定。结果：所有患者获得随访,时间8~24个月,平均11个月。术后6个月随访时根据Karlsson评定标准A级42例,B级13例,C级1例。Constant-Murley肩关节功能总分由术前的（42.80±5.43）分提高至术后6个月的（91.75±4.27）分。术后6个月各项评分均优于术前（P〈0.05）,其中优48例,良7例,差1例。所有患者随访期间均未出现肩关节粘连,钢板螺钉松动、断裂。结论：双Endobutton钢板重建喙锁韧带联合Ⅰ期肩锁韧带修复治疗Ⅲ度以上肩锁关节脱位早期临床疗效满意,有利于肩关节功能早期恢复。

Objective：To explore clinical efficacy of double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage Ⅰ in treating acromioclavicular dislocation with Rockwood type Ⅲ- Ⅴ.Methods：From January 2010 to September 2013,56 patients with Rockwood type Ⅲ- Ⅴ acromioclavicular dislocation were treated by operation,including 20 males and 36 femlaes,aged from 32 to 52 years old with an average of 38.5 years old. Twenty five patients were on the left side and 31 cases on the right side. The time from injury to operation was from 3 to 14 days,averaged 7 days. All patients were diagnosed as acromioclavicular dislocation with Rockwood type Ⅲ- Ⅴ,and double Endobutto were used to reconstituting coracoclavicular ligament,line metal anchors were applied for repairing acromioclavicular ligament.Postoperative complications were observed,Karlsson and Constant-Murley evaluation standard were used to evaluate clinical effects. Results：All patients were followed up from 8 to 24 months with average of 11 months. According to Karlsson evaluation standard at 6 months after operation,42 cases were grade A,13 were grade B and 1 was grade C. Constant-Murley score were improved from（42.80±5.43） before operation to（91.75±4.27） at 6 months after operation. All items at 6 months after operation were better than that of preoperative items. Forty eight patients got excellent results,7 were moderate and only 1 with bad result. No shoulder joint adhesion,screw loosening or breakage were occurred during following up. Conclusion：Double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage Ⅰ for the treatment of acromioclavicular dislocation with Rockwood type Ⅲ- Ⅴ could obtain early staisfied clinical effects,and benefit for early recovery of shoulder joint function.