自体掌长肌移植重建喙锁韧带联合带线锚钉固定治疗肩锁关节脱位临床分析

Autogenous palmaris longus muscle transplantation reconstruction of coracoclavicular ligament combined with wire anchor screw fixation for acromioclavicular joint dislocation

目的 探讨应用自体掌长肌移植重建喙锁韧带联合带线锚钉固定治疗肩锁关节脱位（acromioclavicular joint dislocation,AJD）的方法。方法 Rockwood分型Ⅲ-Ⅴ型AJD患者46例,采取自体掌长肌移植重建喙锁韧带＋带线锚钉固定维持锁骨于复位状态。比较治疗前、后患者视觉模拟评分（visual analogue scale,VAS）、Rockwood肩关节功能评分,比较术后7d、1a喙锁间距和肩锁关节间隙。结果 术后随访（15.46±4.68）个月,术后1a,患者VAS评分[（0.08±0.02）分]低于术前[（9.86±0.32）分],Rockwood评分[（12.44±1.39）分]高于术前[（4.68±0.55）分],治疗前、后比较差异有统计学意义（P〈0.01）;术后1a,患者喙锁间距[（12.04±0.72）mm]、肩锁关节间隙[（3.82±1.14）mm]与术后7d[（11.96±0.68）mm、（3.70±1.03）mm]比较差异无统计学意义（P〉0.05）;治疗优良率95.7%,无并发症发生。结论 自体掌长肌移植重建喙锁韧带联合带线锚钉固定治疗AJD疗效确切,可有效改善患者肩关节功能,降低疼痛感,手术操作简单、安全。

Objective To explore the application of autogenous palmaris longus muscle transplantation reconstruction of coracoclavicular ligament combined with wire anchor screw fixation for acromioclavicular joint dislocation （AJD）. Methods Forty-six cases of Rockwood III to V AJD received autogenous palmaris longus muscle transplantation reconstruction of coracoclavicular ligament combined with wire anchor screw fixation to hold the clavicle at the reset state. Visual analogue scale （VAS） and Rockwood shoulder function score were compared before and after operation, and coracoid space and acromioclavicular joint space were compared 7 days and 1 year after operation. Results All patients were followed up for （15.46±4.68） months. VAS score was lower 1 year after operation （0.08±0.02） than that before operation （9.86 ± 0.32）, and Rockwood score was higher after operation （12. 44±1. 39） than that before operation （4.68±0.55） （P〈0.01）. Coracoid space （（12.04±0.72）mm） and acromioclavicular joint space （（3.82±1.14） mm） 1 year after operation showed no significant differences in comparison with those 7 days after operation （（11.96 ± 11.96）, （3.70± 1.03） mm） （P〉0.05）. The excellent and good rate was 95.7%. No complications occurred. Conclusion Autogenous palmaris longus muscle transplantation reconstruction of coracoclavicular ligament combined with wire anchor screw fixation is effective for AJD, and can effectively improve shoulder joint function and decrease pain. The operation is simple and safe.