关节镜下喙锁韧带重建悬吊式固定治疗急性肩锁关节脱位及MRI随访

Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation for management of acute acromioclavicular joint dislocation and MRI follow-up study

目的:探讨关节镜下应用双Endobutton钢板重建喙锁韧带悬吊式固定治疗肩锁关节脱位的安全性和有效性。方法:2016年1月至2017年12月采用双Endobutton钢板重建喙锁韧带悬吊式固定治疗急性肩锁关节脱位18例,术后第2天、6个月、12个月复查X线平片,术后1年进行MRI复查,并采用视觉模拟评分法(Visual Analogue Scale,VAS)、美国肩肘外科协会评分(Rating Scale of the American Shoulder and Elbow Surgeons,ASES)及美国加州大学肩关节评分(University of California at Los Angeles Shoulder Rating Scale,UCLA)进行主观和客观评分。结果:患者均得到随访,随访时间12~30(平均18)个月。术后无1例出现感染、神经血管损伤、内固定松动断裂、脱位复发、锁骨骨折、喙突骨折等并发症。术后X线检查肩锁关节均复位良好。术后1年行MRI复查显示肩锁关节无明显脱位,喙锁间隙恢复良好。术后肩关节功能,VAS,ASES,UCLA和喙锁间距较术前均明显改善,差异均有统计学意义(均P<0.05)。结论:关节镜下双Endobutton重建喙锁韧带钢板悬吊式固定治疗急性肩锁关节脱位具有创伤小、功能恢复快、并发症少等优势,早期的临床效果较好。

Objective:To explore the safety and effectiveness of arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation.Methods:From January 2016 to December 2017,18 cases of acute acromioclavicular joint dislocation were carried out with arthroscopic reconstruction of coracoclavicular ligament by double Endobutton plate suspensory fixation.Anteroposterior view X-ray plain radiographs were obtained on the second day,6 months and 12 months after the surgery,MRI was performed in 1 year after operation.Meanwhile,subjective and objective scoring were obtained by Vsual Analogue Scale(VAS),Rating Scale of the American Shoulder and Elbow Surgeons(ASES)and University of California at Los Angeles Shoulder Rating Scale(UCLA).Results:All patients were followed up for 12 to 30 months(an average of 18 months).There was no patient with infection,neurovascular injury,loosening and breakage of internal fixation,re-dislocation of acromioclavicular joint,clavicular fracture,coracoid process fracture,etc.Postoperative X-ray showed that all acromioclavicular joints were completely relocated.The follow-up of MRI after 1 year showed no obvious dislocation of acromioclavicular joint and good recovery of acromioclavicular space.Postoperative shoulder joint function,VAS,ASES,UCLA and acromioclavicular distance were significantly improved compared with those before surgery,with statistically significant differences(all P<0.05).Conclusion:Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation has the advantages of minimal invasive,rapid functional recovery and less complications and satisfactory early clinical results.