自体腓骨长肌腱前侧半重建喙锁韧带治疗肩锁关节脱位

Coracoclavicular ligament reconstruction with the autogenous anterior half of the peroneus longus tendon for acromioclavicular joint dislocations

目的探讨自体腓骨长肌腱前侧半（AHPLT）重建喙锁韧带治疗肩锁关节脱位的临床疗效。方法回顾性分析2013年6月至2015年4月期间利用自体AHPLT重建喙锁韧带治疗的24例RockwoodⅢ-Ⅴ型肩锁关节脱位的患者资料。男20例，女4例；年龄22—68岁，平均50．7岁；左侧15例，右侧9例。骨折Rockwood分型：Ⅲ型5例，Ⅳ型5例，Ⅴ型14例；20例为新鲜脱位患者，4例为陈旧性脱位患者。记录术前及术后1、3．6、12个月的肩关节Constant评分、美国足踝外科学会（AOFAS）的踝-后足评分、疼痛视觉模拟评分（VAS），并通过影像学分析复位是否丢失。结果20例患者完成术后6个月及12个月随访，4例患者未获完整随访。术后6、12个月20例患者患侧Constant评分分别为81、96分，健侧均为96分。术后6个月Constant评分小于健侧；术后6、12个月Constant评分均较术前（50分）显著提高；术后12个月Constant评分较术后6个月显著提高，以上项目比较差异均有统计学意义（P〈0．05）。术后6、12个月20例患者患侧AOFAS的踝．后足评分均为100分，健侧为100分，健侧与患侧比较差异均无统计学意义（P〉0．05）。术后6、12个月患者患侧VAS评分分别为2、0分，均较术前（5分）降低，差异均有统计学意义（P〈0．05）；术后12个月VAS评分比术后6个月降低，差异有统计学意义（P〈0．05）。影像学检查提示术后12个月20例患者中4例（20％）发生复位丢失，复位丢失与术后12个月Constant评分无显著相关性（P〉0．05）。1例患者术后12个月随访时诉肩关节疼痛。无锁骨、喙突骨折、感染等并发症发生。结论自体AHPLT移植解剖重建喙锁韧带是治疗肩锁关节脱位的一种有效方法。AHPLT取腱过程安全、简单，具有足够的长度，可以作为喙锁韧带重建的一种可靠的自体韧带材料。

Objective To report the clinical and radiological outcomes of coracoclavicular ligament reconstruction with an autogenous anterior half of the peroneus longus tendon （AHPLT） for acromioclavicular （AC） joint dislocations. Methods Between June 2013 and April 2015, a total of 24 patients with AC joint dislocation of Rockwood types m to v underwent surgical repair using coracoclavicular ligament reconstruction with an autogenous AHPLT graft. They were 20 men and 4 women, aged from 22 to 68 years （average, 50. 7 years）. The left side was affected in 15 cases and the right in 9. According to Rockwood classification, there were 5 cases of type Ⅲ, 5 ones of type Ⅳ and 14 ones of type V. Twenty of them had acute injury and 4 chronic injury. They were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively in terms of the Constant score, American Orthopedic Foot and Ankle Society（AOFAS） ankle-hindfoot score, visual analogue scale （VAS） score, and loss of reduction on radiographs. Results Twenty patients completed clinical and radiographic follow-ups at 6 and 12 months postoperatively while the other 4 did not. At postoperative 6 and 12 months, the Constant scores were 81and 96 for the affected side and both 96 for the healthy side, respectively. The Constant score at 6 months for the affected side was significantly lower than that for the healthy side （ P 〈 0.05）; the Constant scores at 6 and 12 months were significantly higher than the preoperative one （50） （ P 〈 0.05）; the Constant score for the affected side at 12 months was significantly higher than that at 6 months （ P 〈 0.05） . At 6 and 12 months, the AOFAS scores were both 100 for the affected side and both 100 for the healthy side as well. There were no significant differences in AOFAS score between the affected and healthy sides （ P 〉 0.05）. At postoperative 6 and 12 months, the VAS scores for the affected side were 2 and 0 respectively, significantly lower than the preoperative one （5） （ P 〈 0. 05）. The VAS score at 12 months was significantly lower than that at 6 months （ P 〈 0. 05）. Loss of reduction occurred in 4 cases （20%）, showing no significant correlation with the Constant scores at postoperative 12 months （ P 〉 0. 05）. One patient complained of shoulder pain at postoperative 12 months. No surgical site infection or perioperative fracture was observed. Conclusions Coracoclavicular ligament reconstruction with an autogenous AHPLT proves effective for AC joint dislocations. Since it is easy and safe to harvest an autogenous AHPLT and the usable length of AHPLT graft is sufficient for reconstruction, autogenous AHPLT may be a reliable alternative to the present tendon graft sources for coracoclavicular ligament reconstruction.