内固定及韧带重建治疗肩锁关节脱位的效果

INTERNAL FIXATION AND LIGAMENT RECONSTRUCTION FOR ACROMIOCLAVICULAR JOINT DISLOCATION

目的探讨内固定及韧带重建治疗肩锁关节脱位的效果。方法肩锁关节脱位病人66例,其中34例应用锁骨钩钢板固定肩锁关节（钢板固定组）,32例在锁骨钩钢板固定肩锁关节基础上,行斜方肌筋膜瓣重建肩锁、喙锁韧带（韧带重建组）,术后4-6个月拆除内固定时留取少量筋膜组织,分别进行苏木精-伊红及免疫组织化学染色,观察筋膜形态学特点及成纤维细胞和Ⅰ、Ⅲ型胶原表达情况。比较两组病人术后2年肩关节Constant评分、喙突上平面与锁骨下平面的垂直距离（CC.Dist）、核磁共振定量分析韧带噪声比（SNQ）。结果病人随访2-4年,韧带重建组术后并发症发生率显著低于对照组（χ2=32.20,P〈0.01）。两组Ⅰ、Ⅲ型胶原含量和Ⅰ/Ⅲ型胶原比值比较,差异有显著性（t=8.00-9.96,P〈0.05）。术后2年,两组患侧肩关节Constant评分、CC.Dist及SNQ比较,差异有显著性（t=2.30-55.03,P〈0.05）。结论内固定及韧带重建治疗肩锁关节脱位,肩关节功能改善明显,术后韧带愈合可靠。

Objective To assess the effectiveness of internal fixation and ligament reconstruction in treatment of acromioclavicular joint （ACJ） dislocation. Methods Sixty-six patients with ACJ dislocation were selected, of whom,34 were treated with internal fixation of ACJ using clavicle hook plate （plate fixation group）, and the other 32 received additional reconstruction of coracoclavicular ligaments （ligament reconstruction, LR group） on the basis of that used in the plate fixation group. After 4-6 months of surgery, the internal fixation was removed, and a small amount of fascia tissue taken for HE-and immunohistochemical staining. The fascia morphological characteristics and expressions of fibroblasts and collagen types Ⅰ and Ⅲ were observed. Two years after surgery, the Constant shoulder scores, CC. Dist and SNQ of MRI were compared between the two groups. Results The patients were followed up for 2-4 years. The incidence of postoperative complications in LR group was lower than that in the plate fixation group （x^2 =32.20,P〈0.01）. There was significant difference in Ⅰ,Ⅲ collagen content and Ⅰ/Ⅲ collagen ratio betwen the two groups （t = 8.00-9.96, P〈0.05）. Two years after surgery, the differences in Constant score of affected side shoulder joint, CC.Dist and SNQ between the two groups were significant （t=2.30-55.03,P〈0.05）. Conclusion Internal fixation and ligament reconstruction for acromioclavicular joint dislocation markedly improve the function of shoulder joint and postoperative tendon healing is reliable.