全关节镜下Twin Tail TightRope结合远端关节囊修复技术治疗急性肩锁关节脱位

Arthroscopic Twin Tail TightRope combined with distal joint capsule repair technique for acute acromioclavicular dislocation

目的探讨全关节镜下Twin Tail TightRope结合远端关节囊修复技术治疗急性肩锁关节脱位。方法回顾分析2016年2月-2017年12月收治的40例肩锁关节脱位患者临床资料,根据手术方式不同分为关节镜组(20例,全关节镜下使用Twin Tail TightRope结合远端关节囊修复治疗)和对照组(20例,采用锁骨钩钢板内固定治疗)。两组患者性别、年龄、致伤原因、Rockwood分型、受伤至手术时间及术前疼痛视觉模拟评分(VAS)、Constant评分等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术后采用VAS评分及Constant评分评估肩关节功能,并观察有无再次脱位。结果两组患者术后切口均Ⅰ期愈合,无术后早期并发症发生。两组患者均获随访,随访时间12~18个月,平均13.5个月。术后X线片示两组均获得良好的解剖复位,但对照组均有锁骨钩于肩峰下间隙占位表现。关节镜组患者术后均获得满意的肩关节功能,重返工作岗位;无明显疼痛以及内固定物外露等并发症发生,并且无需取出内固定物。对照组4例患者术后出现较明显的肩峰下撞击痛,1例患者于术后1年取出内固定物后发生再脱位;其余患者未发现内固定相关并发症,于术后1.0~1.5年取出内固定物,无再脱位发生。两组患者术后3个月和1年的VAS评分及Constant评分均较术前显著改善,术后1年较术后3个月进一步改善,差异均有统计学意义(P<0.05)。关节镜组术后3个月和1年的VAS评分及Constant评分均显著优于对照组,差异有统计学意义(P<0.05)。结论全关节镜下Twin Tail TightRope结合远端关节囊修复技术治疗急性肩锁关节脱位短期疗效满意,与传统切开手术相比,其微创特点使得患者依从性更高、术后恢复更满意。

Objective To investigate arthroscopic treatment for acute acromioclavicular dislocation by using Twin Tail TightRope combined with distal joint capsular repair. Methods The clinical data of 40 patients with acromioclavicular dislocation treated between February 2016 and December 2017 were retrospectively analyzed. The patients were divided into arthroscopic group(20 cases, using arthroscopic Twin Tail TightRope combined with distal joint capsular repair for anatomical repair of stable structure of acromioclavicular joint) and control group(20 cases,treated with clavicular hook plate internal fixation) according to different surgical methods. There was no significant difference in gender, age, cause of injury, Rockwood classification, time from injury to operation, preoperative visual analogue scale(VAS) score and Constant score between the two groups(P>0.05), which were comparable. Postoperative VAS score and Constant score were used to assess shoulder function and re-dislocation was also observed. Results The incisions of the two groups healed by first intention, and no early postoperative complications occurred. All patients were followed up 12-18 months(mean, 13.5 months). Postoperative X-ray films showed good anatomical reduction in both groups,but the clavicular hook had a presense in the subacromial space in control group. All patients in arthroscopic group achieved satisfactory shoulder function and returned to work after operation;there was no obvious pain, no complications such as exposure of implant after operation, and no need to remove the implant. In the control group, 4 patients had obvious subacromial impingement pain after operation, and 1 patient had re-dislocation after removal of internal fixator at 1 year after operation;the rest had no complications related to internal fixation, and the internal fixators were removed at 1.0-1.5 years after operation, without re-dislocation. The VAS score and Constant score at 3 months and 1 year after operation in both groups significantly improved when compared with those before operation, and further improved at1 year after operation(P<0.05). The VAS score and Constant score at 3 months and 1 year after operation in arthroscopic group were significantly better than those in control group(P<0.05). Conclusion Arthroscopic treatment for acute acromioclavicular joint dislocation by using Twin Tail TightRope combined with distal capsular repair is more effective than traditional incision surgery and can obtain more satisfactory results in patient compliance and function recovery because of minimally invasive surgery.