关节镜下细骨道双Endobutton钢板联合Fiberwire缝线治疗Rockwood Ⅲ~Ⅴ型肩锁关节脱位

Arthroscopic double-Endobutton with Fiberwire suture through tenuous bone tunnel in the treatment of Rockwood type Ⅲ-Ⅴ acromioclavicular joint dislocation

目的探讨关节镜下细骨道双Endobutton钢板联合Fiberwire缝线治疗Rockwood Ⅲ~Ⅴ型肩锁关节脱位的手术方法和临床效果。方法2019年6月至2020年6月本院收治12例肩锁关节脱位患者,其中男9例、女3例;年龄31~65岁,平均(41.7±2.5)岁;左侧3例,右侧9例;受伤至手术时间2~7 d,平均(4.2±1.7)d。术前X线片和三维CT显示肩锁关节完全脱位,Rockwood分型Ⅲ型8例、Ⅳ型1例、V型3例。所有患者均在关节镜下行肩锁关节复位细骨道双Endobutton钢板联合Fiberwire缝线固定术。所有患者术后第1天、1个月、6个月复查X线和三维CT,术前和术后1、3、6个月分别进行美国肩肘外科医师评分(American shoulder and elbow surgeons,ASES)、Constant评分、视觉模拟评分(visual analogue score,VAS)、肩关节活动度评估。结果所有患者术后均获随访,随访时间7~10个月,ASES评分、Constant评分术后第1、3、6个月与术前比较明显增高,差异有统计学意义(P<0.05)。VAS评分术后第1、3、6个月与术前比较明显下降,差异有统计学意义(P<0.05)。肩关节前屈、外展活动度术后第1、3、6个月与术前比较明显改善,差异有统计学意义(P<0.05)。术后1个月三维CT测量情况:骨道直径(2.34±0.12)mm,复位无丢失。末次随访X线片和三维CT显示所有患者均未出现复位丢失和喙突或锁骨骨折。1例患者术后2个月出现继发性冻结肩,予以盂肱关节注射倍他米松后缓解。结论关节镜下细骨道双Endobutton钢板联合Fiberwire缝线治疗Rockwood Ⅲ~Ⅴ型肩锁关节脱位具有创伤小、锁骨和喙突骨量损失小、复位和固定可靠的优点,潜在降低再骨折和复位丢失的发生率。

Background Acromioclavicular joint dislocation is a common disease of orthopedics. It is difficult to immobilize after manual reduction and has a higher operation rate. The safety and efficacy of arthroscopic double-Endobutton with Fiberwire suture through tenuous bone tunnel in the treatment of acromioclavicular joint dislocation have been confirmed. However, a few patients still have complications such as iatrogenic fracture and reduction loss, which are related to the thick bone canals of coracoid process and clavicle, or the decreased bone strength due to repeated drilling processes. Objective To investigate the surgical method and clinical efficacy of arthroscopic double-Endobutton with Fiberwire suture through tenuous bone tunnel in the treatment of Rockwood type Ⅲ-Ⅴ acromioclavicular joint dislocations. Methods From June 2019 to June 2020, a total of 12 patients(9 males and 3 females) with acromioclavicular joint dislocations were admitted and treated. The ages ranged from 31 to 65(41.7±2.5) years old. There were 3 left cases and 9 right cases. The time from injury to operation was 2 to 7(4.2±1.7) days. Preoperative X-ray and CT scan showed complete dislocations of acromioclavicular joint. According to Rockwood classification, there were 8 type III cases, 1 type IV case and and 3 type V cases. All patients underwent arthroscopic reduction and double-Endobutton fixation with Fiberwire suture through tenuous bone tunnel, and received postoperative re-examinations including X-ray and 3 D CT immediately after the operation and on the 1 st day, 1 st month, and 6 th month after operation. All patients were assessed using the rating scale of American shoulder and elbow surgeons(ASES), Constant score, visual analogue scale(VAS) and shoulder range of motion before operation, and 1 month, 3 months and 6 months after operation. Results The ASES scores and Constant scores significantly increased in the 1 st, 3 rd and 6 th months after operation compared with hose before operation, and there were statistical differences(P < 0.05). The VAS scores decreased significantly in the 1 st, 3 rd and 6 th months after operation(P < 0.05). The ranges of motion of shoulder flexion and abduction significantly improved in the 1 st, 3 rd and 6 th months after operation(P < 0.05). One month after surgery, the diameter of bone tunnel was(2.34±0.12)mm measured by 3 D CT without reduction loss. At the last follow-up, the X-ray films and CT scans of all patients showed no reduction loss or fractures of coracoid process or clavicle. One patient had secondary frozen shoulder 2 months after operation which was relieved by injecting betamethasone into the glenohumeral joint. Conclusion The arthroscopic double-Endobutton with Fiberwire suture through tenuous bone tunnel in the treatment of Rockwood type Ⅲ-Ⅴ acromioclavicular joint dislocations has the advantages of minimal trauma, less bone loss of clavicle and coracoid process, and reliable reduction and fixation, and can potentially reduce the incidence of refracture and reduction loss.