带线锚钉技术治疗创伤性胸锁关节脱位43例

Treatment of 43 cases of traumatic dislocation of the acromioclavicular joint by suture anchor technique

目的分析带线锚钉技术治疗胸锁关节脱位的临床疗效。方法回顾性观察分析浙江新安国际医院2015年1月至2017年12月收治的43例胸锁关节完全脱位患者临床资料,所有患者采用带线锚钉技术进行切开复位固定,其中男性27例,女性16例;年龄21～55岁,平均33.2岁;右侧29例,左侧14例;车祸伤31例,高处坠落伤12例。所有患者均为闭新鲜脱位,合并多发肋骨骨折7例,1例脾破裂并严重血气胸,先急诊脾切除、胸腔闭式引流术,后行连枷胸行胸廓成形术同时给予胸锁关节脱位切开复位带线锚钉固定。33例属Grade分型Ⅲ型,即胸锁韧带、肋锁韧带完全断裂,关节囊破坏,锁骨端向前上方脱位。所有患者伤后2～10 d手术治疗,平均5.5 d。术后根据X线片及CT进行观察胸锁关节复位情况,肩关节功能根据Rockwood评分法进行评定。结果本组病例术后随访12～22个月,平均12.5个月。术后外观均获得改善,无局部隆起、肿胀等。Rockwood评分法评定术后关节功能:优32例,良9例,可1例。所有病例未发现感染及内固定松动失效、关节再脱位等并发症及无需二次手术取出内固定物。结论带线锚钉治疗胸锁关节脱位固定可靠、疗效满意,动态固定符合微动关节生理特性,且不需要二次手术行内固定物取出,能达到良好的临床效果和满意度,是治疗胸锁关节脱位一种较好的治疗方法。

Objective To analyze the clinical effect of suture anchor technique in the treatment of traumatic dislocation of the clavicular joint.Methods The clinical data of 43 patients with complete dislocation of the sternoclavicular joint admitted to Zhejiang Xin'an International Hospital from January 2015 to December 2017 were retrospectively analyzed.All patients were treated by open reduction and fixation using the suture anchor technique,including 27 males and 16 females.The patients ranged in age from 21 to 55 years,with an average age of 33.2 years.There were 29 right clavicular joint dislocations and 14 left clavicular joint.Thirty one cases were due to traffic accidents and 12 cases due to high falling injuries.All patients had fresh dislocation,seven cases had multiple rib fractures,and one case had splenic rupture and severe hemopneumothorax.Emergency splenectomy and closed thoracic drainage were performed first,followed by thoracoplasty.Sternoclavicular joint dislocation was then treated by open reduction and suture anchor fixation.Thirty-three cases belonged to gradeⅢ,whose manifestations included complete rupture of the sternoclavicular ligament and costoclavicular ligament,destruction of the articular capsule and dislocation of the clavicular end.All patients were treated with 2-10 d,with an average of 5.5 d.After operation,the reduction of the sternoclavicular joint was observed by X-ray and CT,and shoulder joint function was evaluated by Rockwood score.Results The patients were followed for 12-22 months with an average of 12.5 months.The appearance was improved without local eminence or swelling.The Rockwood scoring system was used to evaluate postoperative joint function,with excellent results achieved in 32 cases,good in 9 cases,and fair in 1 case.No complications such as infection,loosening of internal fixation,re-dislocation of the joint and removal of the internal fixator by a second operation were found in all cases.Conclusion The treatment of sternoclavicular joint dislocation by suture anchor technique is reliable and effective.Dynamic fixation conforms to the physiological characteristics of fretting joint.It does not need a second operation to remove the internal fixator but achieve good clinical effects and satisfaction.