关节镜下重建喙锁韧带并修复肩锁韧带治疗Rockwood Ⅲ型肩锁关节脱位

Clinical effect of coracoclavicular ligament reconstruction and acromioclavicular ligament repair in the treatment of Rockwood Ⅲ acromioclavicular dislocation under arthroscopies

目的探讨关节镜下重建喙锁韧带并修复肩锁韧带治疗RockwoodⅢ型肩锁关节脱位的临床疗效。方法对我科2011年3月至2016年8月收治的60例RockwoodⅢ型肩锁关节脱位病人进行回顾性分析。其中男34例,女26例;左肩36例,右肩24例。年龄为23~48岁,平均年龄为(29.3±6.2)岁。受伤至手术时间为3~12 d,平均为(6.1±2.5)d。根据手术方法不同分为两组:修复组30例,使用关节镜下Endobutton技术重建喙锁韧带,采用5#爱惜帮聚酯纤维缝线修复肩锁韧带;对照组30例,使用关节镜下Endobutton技术重建喙锁韧带,不修复肩锁韧带。比较两组病人术后1年的肩锁关节前后位X线片的喙锁间隙数值以及术后1年的Constant-Murley肩关节功能评分。结果随访时间为14~24个月,平均为(16±2.7)个月。所有病人手术切口均一期愈合,愈合时间为14~18 d,平均为(13±3.8)d,均无血管神经损伤。术后1年,修复组的喙锁间隙数值为(12.9±0.6)mm,优于对照组的(13.6±1.1)mm;修复组的Constant-Murley肩关节功能评分总分为(91.1±2.4)分,优于对照组的(86.3±3.5)分;上述指标组间差异均有统计学意义(P均<0.05)。结论关节镜下应用Endobutton技术重建喙锁韧带同时修复肩锁韧带治疗RockwoodⅢ型肩锁关节脱位,有利于肩锁关节稳定性及肩关节功能的恢复。

Objective To analyze the clinical effect of coracoclavicular ligament reconstruction and acromioclavicular ligament repair in the treatment of Rockwood typeⅢacromioclavicular dislocation under arthroscopes.Methods From March2011to August2016,60patients with Rockwood typeⅢacromioclavicular dislocation were treated by arthroscopic coracoclavicular ligament reconstruction.There were34males and26females aged from23to48years(average29.3±6.2years)with36cases on the left side and24on the right side.The time from injury to operation was3-12days(average6.1±2.5days).We reconstructed the coracoclavicular ligament with arthroscopic Endobutton technique in two groups.Thereafter the acromioclavicular ligament was sutured with5#Ethibond polyester fiber in experimental group.Instead,we did nothing in control group.One year later,we compared the coracoclavicular distance in X-ray and the Constant-Murley score to evaluate the clinical efficacy.Results All patients were followed up for14-24months(average16±2.7months).All patients obtained postoperative incision healing.The healing time was14-18days(average13±3.8days).All patients had no vascular nerve injury.One year after operation the coracoclavicular distance was(12.9±0.6)mm in experimental group,and(13.6±1.1)mm in control group(P<0.05).At the time of last follow-up,the Constant-Murley score was(91.1±2.4)in experimental group and(86.3±3.5)in control group(P<0.05).Conclusion Arthroscopic Endobutton technique and acromioclavicular ligament repair to treat Rockwood typeⅢacromioclavicular dislocation can achieve a better stability and better function of shoulder.