关节镜下肩锁关节囊联合喙锁韧带重建手术治疗急性肩锁关节脱位的疗效分析

Arthroscopic reconstruction of acromioclavicular joint capsule and coracoclavicular ligament for treatment of acute acromioclavicular joint dislocation: an analysis of clinical effect

目的 观察关节镜下肩锁关节囊联合喙锁韧带重建手术治疗RockwoodⅢ、Ⅳ型肩锁关节脱位的临床疗效。方法回顾性分析自2019-01—2020-12诊治的42例RockwoodⅢ、Ⅳ型急性肩锁关节脱位,22例在关节镜下进行肩锁关节囊联合喙锁韧带重建手术治疗(观察组),20例关节镜下单纯进行喙锁韧带重建手术治疗(对照组)。比较两组术后并发症发生率、疼痛VAS评分、肩关节功能Constant-Murley评分、喙锁距离、肩锁距离。结果 42例均获得随访,随访时间平均21(13~36)个月。观察组术后1例切口延迟愈合,未出现内固定失效、肩锁关节半脱位,并发症发生率为4.5%。对照组术后1例切口延迟愈合,2例内固定失效,4例肩锁关节半脱位,并发症发生率为35.0%。观察组术后并发症发生率明显低于对照组,差异有统计学意义(P=0.038)。观察组术后3个月、术后6个月、末次随访时疼痛VAS评分与肩关节功能Constant-Murley评分优于对照组,且术后3个月、术后6个月、末次随访时喙锁距离与肩锁距离均小于对照组,差异有统计学意义(P<0.05)。结论 关节镜下肩锁关节囊联合喙锁韧带重建手术治疗急性肩锁关节脱位安全有效,允许患者早期功能锻炼,可避免内固定物失效,并获得良好的肩关节功能恢复。

Objective To observe the clinical effect of arthroscopic reconstruction of the acromioclavicular joint capsule andcoracoclavicular ligament in the treatment of Rockwood type Ⅲ, Ⅳ acromioclavicular joint dislocation.Methods A retrospec-tive analysis was performed on 42 cases of acute Rockwood type Ⅲ, Ⅳ acromioclavicular joint dislocation diagnosed and treat-ed from January 2019 to December 2020. In the observation group 22 cases underwent arthroscopic reconstruction of the acro-mioclavicular joint capsule and coracoclavicular ligament while in the control group 20 cases underwent arthroscopic reconstruc-tion of coracoclavicular ligament alone. Further comparison was conducted on the incidence of postoperative complications,VAS score of postoperative pain, Constant-Murley score of shoulder joint function, coracoclavicular distance and acromioclavic-ular distance.Results All 42 cases were followed up for an average of 21(13-36) months. In the observation group, 1 case haddelayed wound healing, without no internal fixation failure or subluxation of the acromioclavicular joint, and the incidence rateof complication was 4.5%. Meanwhile, in the control group, 1 case had delayed wound healing, 2 cases internal fixation failure,and 4 cases subluxation of acromioclavicular joint, with the incidence rate of complication of 35.0%. The incidence of postopera-tive complications in the observation group was significantly lower than that in the control group, with a statistically significantdifference(P=0.038). Furthermore, at 3 months, 6 months after the operation and the last follow-up, the VAS score of postopera-tive pain and Constant-Murley score of shoulder joint function in the observation group were better than those in the controlgroup, and the coracoclavicular distance and acromioclavicular distance in the observation group were smaller than those in thecontrol group, with statistically significant differences(P<0.05).Conclusion Arthroscopic reconstruction of the acromioclavic-ular joint capsule and coracoclavicular ligament is safe and effective for the treatment of acute acromioclavicular joint dislocation. The proposed therapeutic approach allows patients to exercise early after the operation, avoids internal fixation failure, andachieves good functional recovery of the shoulder joint.