喙锁韧带的解剖学重建治疗锁骨远端骨折的疗效观察

Application of the method of anatomic coracoclavicular ligament reconstruction for distal clavicle fractures

目的探讨喙锁韧带原止点解剖学重建的方法治疗锁骨远端骨折的疗效。 方法2013年8月至2015年1月南京医科大学第一附属医院骨科的锁骨远端的患者16例，术前应用Supraimaging系统对患者的CT数据进行测量，对骨折的形态学特征及肩锁关节的脱位程度进行评估，参照以往对喙锁韧带止点研究的数据，对喙锁韧带的损伤进行判断，并和术中具体探查的结果进行验证，对患者进行喙锁韧带原止点的重建，辅助以小螺钉或线猫固定小骨块治疗。于术后1、3、6、12个月复查锁骨正位片，并测量喙锁间距，评估骨折复位状况，同时对患者行肩关节功能评分（Constant－Murley）。 结果所有患者均获得了良好的骨折及肩锁关节的复位，随访时间6～22（12.6±3.9）个月，在术后6个月骨折愈合。喙锁间距术后1个月为（7.8±1.4）mm，末次随访为（7.9±1.2）mm，P＝0.06。Constant－Murley评分术后1个月为（49.1±4.4）分，末次随访（93.8±2.1）分，P〈0.01。术后未见肩锁关节复位的明显丢失，未有喙突和锁骨骨折的发生，骨折愈合良好，肩关节功能良好，恢复正常的生活和工作。 结论锁骨远端骨折有别于中段骨折，骨折的同时伴有韧带的损伤，喙锁韧带的损伤是肩锁关节不稳定的主要病因，是手术的重点，故应用喙锁韧带原止点双束重建治疗锁骨远端骨折的方法有良好的临床疗效。

ObjectiveTo assess the clinical results of the method of anatomic coracoclavicular ligament reconstruction for distal clavicle fractures. MethodsFrom August 2013 to January 2015, the super image system was used to measure the CT data of 16 patients suffering distal clavicle fractures before operation in Department of Orthopaedics , the First Affiliated Hospital of Nanjing Medical Univerisity. The fractures′ morphological features and acromioclavicular dislocation degree were assessed. By referring to the data collected by the my research group on Chinese people′s coracoclavicular ligament, the injuries of the coracoclavicular ligament were estimated, which was then to verify the actual injuries detected during operation. Coracoclavicular ligament reconstruction was performed on patients and screws or suture anchors fixing small bone blocks was used as an adjuvant therapy. Clinical and radiological follow-up was at 1, 3, 6 and 12 months after the procedure. The clinical outcomes were assessed pre- and postoperatively with Constant Scores. Anteroposterior radiographs for the bilateral acromioclavicular joints were obtained immediately after surgery and every follow-up.To compare the reduction maintenance, coracoclavicular distances of the injured shoulders were measured in preoperative and postoperative standard radiographs. ResultsAll patients received satisfactory fracture and acromioclavicular joint reduction. The average follow-up period was （12.6±3.9） months （ranging from 6 to 22 months）. Fractures healed six months after the operation. The coracoclavicular distances increased from （7.8±1.4）mm at one month follow-up to （7.9±1.2）mm at the final follow-up （P〉0.05）, which could be considered as no difference statistically. The constant score significantly increased from （49.1±4.4） at one month follow-up to （93.8±2.1） at the final evaluation （P〈0.001）. Obvious loss of acromioclavicular joint reduction was not observed after the operation. Coracoid process and calvicle fractures did not appear. Fractures healed well and shoulder joints also functioned well. Patients′ lives and work went back to normal. ConclusionAccompanied by ligament injuries, distal clavicle fractures is different from middle fractures. Coracoclavicular ligament injury is a major cause of the acromioclavicular joint instability, and the focus of the surgery. Therefore, the application of the double-bundle coracoclavicular ligament reconstruction is a feasible method to treat distal clavicle fractures, displaying satisfying clinical results.