锁骨钩板内固定联合Endobutton韧带重建治疗Rockwood Ⅲ型肩锁关节脱位

Treatment of Rockwood type Ⅲ acromioclavicular joint dislocation with clavicular hook plate internal fixation and Endobutton ligament reconstruction

目的探讨锁骨钩板内固定联合Endobutton喙锁韧带重建治疗RockwoodⅢ型肩锁关节脱位的临床疗效。方法回顾性分析2012年8月至2015年12月北京大学人民医院创伤骨科采用锁骨钩板内固定联合Endobutton喙锁韧带重建治疗RockwoodⅢ型肩锁关节脱位的患者11例,其中男7例,女4例;年龄22~65岁,平均(37.50±8.75)岁。受伤至手术时间为2~8 d,平均(4.50±1.95)d,均为闭合性损伤。损伤机制:直接暴力损伤9例,间接暴力损伤2例。对11例患者进行临床效果评价。结果患者的手术时间35~100 min,术后所有患者切口均为1/甲级愈合。随访时间6~18个月,平均(10.60±6.67)个月。所有患者术后均未发生锁骨钩脱落、断裂。术后10~18个月取出内固定,钢板取出后无再脱位等并发症。按美国肩肘外科协会标准化肩关节评定量表(American shoulder elbow surgeons standardized shoulder assessment form,ASES)评价疗效,优(100~90分)9例,良(89~75分)1例,一般(74~51分)1例,差(≤50分)0例,优良率90.91%。结论锁骨钩板内固定联合Endobutton喙锁韧带重建治疗RockwoodⅢ型肩锁关节脱位手术操作简单,术后肩关节功能恢复好,并发症少,可临床推广应用。

Background Accounting for around 12%of all shoulder injuries,the acromioclavicular joint dislocation is common in clinic.The shoulder joint is prone to acromioclavicular dislocation when direct or indirect high energy violence leads to the rupture of the ligament around joint.Currently,it has been widely acknowledged that Rockwood typeⅢ-V of acromioclavicular joint dislocation should be treated with surgical interventions.Although innovative surgical treatments of acromioclavicular joint dislocation have been reported several times,the optimal treatment is still controversial.The traditional method is based on rigid internal fixation,but high rate of complications and unsatisfactory clinical efficacy are resulted.In recent years,the treatment concept has gradually switched from rigid fixation to elastic fixation,and the treatment of acromioclavicular dislocation through the anatomic reconstruction of acromioclavicular ligament with Endobuttons becomes the focus of research.This study provides a retrospective analysis of 11 cases with Rockwood typeⅢacromioclavicular joint dislocation treated by clavicular hook plate fixation combined with the Endobutton reconstruction of coracoclavicular ligament in our hospital from August 2012 to December 2015.All cases achieved satisfactory therapeutic effect.Methods(1)General information.The group included 11 patients(7 males and 4 females).The age ranged from 22-65 years with an average of(37.50±8.75)years.Six cases had the right side affected,and 5 cases had the left side affected.The time from injury to operation ranged from 2-8 days with an average of(4.50±1.95)days,and all cases were closed injuries.Injury mechanisms:9 cases of direct violent injury and 2 cases of indirect violent injury.No fracture was discovered in patients under fluoroscopy.According to the Rockwood classification,all injuries were acromioclavicular dislocation of Rockwood typeⅢ.Clinical manifestations of ipsilateral shoulder included slight swollen,floating feeling of clavicle,positive'piano sign',local ecchymoses and bruises,tenderness,limitation of shoulder joint motion.(2)Therapeutic method.All patients had the affected limb fixed with suspension braking after admission.After preoperative examination was taken,the patient received brachial plexus block or general anaesthesia and was placed in semirecumbent position for operation.