应用LARS人工韧带行喙锁韧带重建术治疗急性肩锁关节脱位早期临床效果分析

Early Clinical Evaluation of the Coracoclavicular Reconstruction Using LARS Artificial Ligament for Acute Acromioclavicular Joint Dislocation

目的:分析应用LARS人工韧带行喙锁韧带重建术的临床效果。方法:回顾性分析了中日友好医院从2017年2月至2019年2月期间应用LARS人工韧带行喙锁韧带重建术治疗急性肩锁关节脱位共23名患者,其中男性17例,女性6例,平均年龄47.6±11.8岁,平均受伤至手术时间7.3±6.5天,根据Rockwood肩锁关节脱位分型Ⅲ型17例,Ⅳ型1例,Ⅴ型5例。在术前及术后12月随访时对患者进行疼痛VAS评分、Constant-Murley评分,通过术前、术后即刻及术后12月X线测量喙锁间隙评估肩锁关节复位及维持情况。详细记录相关并发症。结果:所有患者均完成不短于12月的随访,平均随访时间21.0±5.8月。VAS评分由术前的6.5±1.4分降至术后的0.5±0.7分,Constant-Murley评分由术前的50.3±9.4分改善至术后的94.7±5.2分,喙锁间隙由术前的15.8±4.0 mm减小至术后12月的8.5±2.2 mm,均具有统计学意义。术后12月随访时18例肩锁关节复位维持良好,4例复位少量丢失,1例复位完全丢失。并发症方面,2例术中应用螺钉固定时出现锁骨纵向劈裂,无移位,1例喙锁间隙内出现异位骨化,1例复位完全丢失。结论:LARS人工韧带行喙锁韧带重建术治疗急性肩锁关节脱位是一种安全有效的治疗手段,能够较好地恢复患者肩关节功能并允许患者早期进行肩关节康复训练。

Objective To analyze the clinical effect of the coracoclavicular ligament reconstruction with ligament augmentation and reconstruction system(LARS)artificial ligament.Methods Twenty-three patients with acute acromioclavicular dislocation and reconstructed using LARS artificial ligament between February 2017 and February 2019 in China-Japan Friendship Hospital were selected,including 17 males and 6 females,with an average age of 47.6±11.8 years and an average injured time of 7.3±6.5 days.According to Rockwood’s classification,17 patients were classified as type Ⅲ,1 and5 patients as type Ⅳ and type Ⅴ respectively.Before and 12 months after the surgery,all patients were evaluated using the visual analogue scale(VAS)score and Constant-Murley score.Before as well as right after and 12 months after the operation,all patients were assessed the reduction and maintenance of acromioclavicular joint using the X-ray.The complications were recorded in details.Results All patients were followed up for no less than 12 months,with an average follow-up time of 21.0±5.8 months.The average VAS score and coracoclavicular space decreased significantly from 6.5±1.4 and 15.8±4.0 mm before the surgery to 0.5±0.7 and 8.5±2.2 mm after that,while the average Constant-Murley score improved significantly from 50.3±9.4 to 94.7±5.2 after the surgery.Twelve months after the surgery,the reduction of acromioclavicular joint was well maintained in 18 cases,with a small loss in 4 cases and complete loss in 1 case.As to the complications,2 cases had nondisplaced intra-operative clavicle fracture,1 of heterotopic ossification in the coracoclavicular space and another 1 of complete loss of reduction.Conclusion The reconstruction of coracoclavicular ligament with LARS artificial ligament is a safe and effective method for the treatment of acute acromioclavicular dislocation.It can restore shoulder function well and allow patients to do early shoulder rehabilitation.