关节镜下喙锁和肩锁韧带重建治疗陈旧性Rockwood Ⅲ型肩锁关节脱位

Arthroscopic reconstruction of acromioclavicular and coracoclavicular ligaments in the treatment of chronic Rockwood type Ⅲ acromioclavicular joint dislocation

目的探讨关节镜下喙锁+肩锁韧带重建治疗陈旧性Rockwood Ⅲ型肩锁关节脱位的疗效。方法选取2016年1月至2020年12月北京大学人民医院收治的14例确诊为陈旧性肩锁关节脱位患者,其中男8例、女6例,平均年龄(37.2±10.1)岁,平均受伤时间(13.4±3.5)个月,累及优势侧肩关节7例,均行关节镜下喙锁+肩锁韧带重建手术。术后所有患者分别于不同时间点随访(术后1、3、6、12个月),进行视觉模拟评分(visual analogue scale,VAS)和美国加州大学洛杉矶分校(University of California,Los Angeles,UCLA)评分。结果14例确诊为陈旧性肩锁关节脱位患者(均为Rockwood Ⅲ型)进入研究并完成手术,12例获得完全随访,平均随访(26.3±8.6)个月(12~36个月)。患者术前和术后1个月、3个月、6个月、12个月VAS评分分别为(5.667±0.414)分、(5.583±0.288)分、(4.583±0.229)分、(2.833±0.271)分、(0.538±0.193)分,与术前相比,所有患者在术后3个月、6个月和12个月随访时均显示疼痛减轻,术后6个月和12个月疼痛减轻的程度与术前相比(VAS评分变化)差异有统计学意义(P<0.001)。患者术前和术后1个月、3个月、6个月、12个月UCLA评分分别为(19.083±0.468)分、(18.583±0.434)分、(21.000±0.628)分、(25.750±0.579)分、(32.750±0.509)分,与术前相比,所有患者在术后3个月、6个月和12个月随访时UCLA评分与术前相比均有提高,术后6个月、12个月随访时UCLA评分改善的程度与术前相比,差异有统计学意义(P<0.001)。结论关节镜下喙锁+肩锁韧带重建可以用较小的创伤达到帮助陈旧性肩锁关节脱位患者减轻疼痛和改善肩关节功能的目的。

Background Acromioclavicular joint dislocation is common in the clinic,mostly in young adults and people who like sports.Patients with less severe injuries,such as Rockwood Ⅰ,Ⅱ,and some Ⅲ,can be treated with conservative therapy with satisfactory results.In contrast,Rockwood types Ⅳ,Ⅴ,and Ⅵ with severe acromioclavicular dislocation require surgery.The most controversial treatment is Rockwood type Ⅲ,where persistent dislocation of the acromioclavicular joint leads to persistent pain and dysfunction due to failure of conservative treatment.However,due to the obsolescence stage at the time of treatment,different clinical reports have a certain incidence of poor reduction,loss of reduction,and residual pain.We proposed the method of coracoclavicular ligament+acromioclavicular ligament reconstruction under arthroscopy,which gives full play to the advantages of minimally invasive surgery and has certain significance for improving postoperative shoulder joint function and alleviating pain.Objective To investigate the effect of arthroscopic reconstruction of coracoclavicular and acromioclavicular ligaments in treating chronic Rockwood type Ⅲ acromioclavicular joint dislocation.Methods A total of 14 patients diagnosed with old acromioclavicular dislocation from January 2016 to December 2020 were selected,including 8 males and 6 females,with an average age of(37.2±10.1)years and an average injury time of(13.4±3.5)months,and 7 patients with dominant shoulder joint involved.All underwent arthroscopic coracoclavicular+acromioclavicular ligament reconstruction.Each patient was followed up at different postoperative time points(1,3,6,12 months after surgery),and pain(VAS score)and shoulder function(UCLA score)were evaluated.Results Fourteen patients diagnosed with obsolete acromioclavicular dislocation(all Rockwood type Ⅲ)entered the study.They completed surgery,and 12 were thoroughly followed up,with a mean follow-up of(26.3±8.6)months(12-36 months).(1)VAS score:Preoperative,postoperative 1 month,3 months,6 months and 12 months scores were(5.667±0.414)point,(5.583±0.288)point,(4.583±0.229)point,(2.833±0.271)point,(0.538±0.193)point,respectively.Compared with pre-operation,all patients showed pain relief at 3,6 and 12 months after surgery,and the degree of pain relief(changes in VAS score)at 6 and 12 months after surgery was statistically improved(P<0.001).(2)UCLA score:Preoperative,postoperative 1 month,3 months,6 months and 12 months scores were(19.083±0.468)point,(18.583±0.434)point,(21.000±0.628)point,(25.750±0.579)point,(32.750±0.509)point,respectively.Compared with pre-operation,UCLA scores of all patients at the 3rd,6th and 12th months follow-up was improved,and the UCLA scores improvement at 6-and 12-months follow-up was statistically different(P<0.001).Conclusion Arthroscopic reconstruction of coracoclavicular and acromioclavicular ligaments can relieve pain and improve shoulder function in patients with chronic acromioclavicular dislocation with less trauma.