自制复位器在镜下喙锁韧带修复重建的应用

A self-developed reposition device used in arthroscopic repairing and reconstruction of coracoclavicular ligament

[目的]介绍自制复位器在关节镜辅助下喙锁韧带修复重建中应用的手术技术与初步临床结果。[方法] 2019年4月~2019年12月,对15例喙锁韧带损伤患者采用镜下修复重建。复位器外观类似锁骨钩钢板,将复位器肩侧钩置于肩峰下,下压锁骨远端,复位肩锁关节脱位或锁骨外端骨折,并于锁骨内侧用1枚螺钉临时固定,维持良好复位。镜下显露喙突下,建立经斜方韧带与锥形韧带锁骨止点的锁骨-喙突骨道,用Endobutton穿过骨道置于喙突下,另加1枚喙突锚钉,在锁骨上方用小钢板固定,完成固定后去除复位器。[结果] 15例患者均顺利完成手术,无严重并发症发生。随访时间4~9个月,末次随访时美国肩肘外科协会评分(American Shoulder and Elbow Surgeons, ASES)、Constant-Murley评分和美国加州大学肩关节评分(University of California at Los Angeles shoulder rating scale, UCLA)均较术前显著增加(P<0.05)。术后影像显示脱位或骨折复位良好,至末次随访时,未见明显再脱位、复位高度丢失及骨隧道扩大。[结论]此自制复位器可在术中稳定维持关节或骨折良好复位,提高手术操作效率,可避免术后复位高度丢失及骨隧道扩大。

[Objective] To introduce the surgical technique and preliminary clinical outcomes of a self-developed reposition device used in arthroscopic repairing and reconstruction of coracoclavicular ligament. [Methods] Between April 2019 and December 2019, a total of 15 patients underwent arthroscopic repairing and reconstruction of coracoclavicular ligament for acromioclavicular dislocation or distal clavicular fractures accompanied with coracoclavicular ligament tears in our department. As the self-developed reposition device looks like to clavicle hook plate in shape, inserted the hook part under the acromion, and press the medial end of the device to reduce the joint dislocation or fractures to anatomic position, fixed the medial end of the device with a screw to maintain the anatomic position. After exposure the under surface of coronoid process by arthroscopic vision, a bone tunnel through conoid ligament insertion on the clavicle and the coronoid process was created, and then an Endobutton was introduced through the tunnel to the under surface of the coronoid process. In addition, anchor suture was inserted on the upper surface of the coronoid process under arthroscopy to repair the trapezoid ligament. After the Endobutton loop and suture of the anchor were fixed on a mini plate on the upper surface of the clavicle firmly in proper tension, and the reposition device was removed. [Results] All the 15 patients had operation performed smoothly without any serious complication. At the latest followup lasted for 4~9 months, the ASES, Constant-Murley and UCLA scores significantly improved compared with those before operation(P<0.05). The radiographs revealed that anatomic reduction of the acromioclavicular joint or distal clavicular fractures achieved in all patients,without remarkable re-dislocation in anyone of them to the final interview. [Conclusion] This self-developed reposition device does maintain a firm reduction of the acromioclavicular dislocation or distal clavicular fractures, and facilitate to repairing and reconstruction of coracoclavicular ligament.