关节镜辅助下肩关节三束重建与锁骨钩钢板固定治疗急性肩锁关节脱位的回顾性对比研究

A retrospective comparative study of arthroscopically assisted 3-Bundle anatomical reduction and hook plate for acute acromioclavicular joint separations

目的分析比较钩钢板技术和肩关节镜辅助下喙锁、肩锁韧带三束重建技术在治疗急性Rockwood Ⅲ~Ⅴ型肩锁关节脱位的临床疗效。方法回顾性分析2017年2月至2018年2月,我院连续收治并获得随访的31例Rockwood Ⅲ~Ⅴ型肩锁关节脱位患者的临床资料。14例采用锁骨钩钢板切开复位内固定定(钩钢板固定组),1年后取除内固定。17例于肩关节镜辅助下采用襻钢板-缝线技术重建喙锁韧带,并用高强度缝线缝扎肩锁韧带间隙的三束重建技术治疗肩锁关节脱位(三束重建组)。术后第1、30、90、180、360天采用Constant-Murley及VAS评分,评估患者肩关节功能及疼痛程度;Karlsson评分评估患者术后疗效;同时拍摄术后肩关节正位X线片,测量肩锁间距及喙锁间距评估是否有肩锁关节复位丢失。结果 31例术后切口均I期愈合,无血管、神经损伤及感染等早期并发症发生。三束重建组中,术中肩关节镜探查发现肩袖损伤3例,其中2例冈上肌撕裂,1例肩胛下肌撕裂;另1例出现肩关节盂唇损伤,1例出现SLAP损伤,均于术中一期修复。末次随访时,三束重建组有2例出现复位轻度丢失,无患者因感觉不适要求取除内固定。钩钢板固定组,术后5例主诉肩部活动不适,功能受限,主动要求取除内固定。而且,钩钢板固定组中,3例出现复位轻度丢失,4例出现肩峰下骨溶解同时伴有肩峰撞击疼痛,肩关节抬举受限。末次随访时,ConstantMurley评分:三束重建组(85.3)分,钩钢板固定组(77)分,差异有统计学意义(P<0.05);Karlsson评分:三束重建组优良率(94.1%),钩钢板固定组优良率(78.6%)分,差异有统计学意义(P<0.05)。结论对于肩锁关节脱位的患者,接受肩关节镜辅助下襻钢板-缝线技术结合肩锁关节韧带修补的三束重建技术,术后肩关节功能恢复及患者满意度均优于钩钢板治疗组,复位维持表现肯定。借助肩关节镜,有助于术中全面排查合并的肩袖及盂唇损伤等合并症,是治疗Rockwood Ⅲ~Ⅴ型新鲜肩锁关节脱位、减少术后并发症的有效方法。

Objective To compare clinical effects of hook plate technique and three-bundle reconstruction of coracoclavicular and acromioclavicular ligament assisted by shoulder arthroscopy in the treatment of acute Rockwood type III-V acromioclavicular joint dislocation.Methods Clinical data of 31 patients with Rockwood type III-V acromioclavicular dislocation who were treated and followed up from February 2017 to February 2018 were retrospectively analyzed.Fourteen patients were treated with open reduction and internal fixation with clavicular hook plate as control group,and the internal fixation was removed 1 year later.Seventeen patients underwent reconstruction of coracoclavicular ligament with loop plate-suture assisted by shoulder arthroscopy,combined with high strength suture to ligate the space of acromioclavicular ligament as three bundle reconstruction to treat acromioclavicular joint dislocation.Constant-Murley and VAS scores were used to evaluate shoulder joint function and pain at 1 month,3 months,6 months and 12 months after operation.Karlsson score was used to evaluate patients’satisfaction after operation.Postoperative shoulder joint X-ray was also taken,acromioclavicular and coracoclavicular spacing were measured to assess whether there was loss of acromioclavicular joint reduction.Results All incisions healed at the first stage after operation,and there were no early complications such as blood vessel,nerve injury or infection.In the shoulder arthroscopic treatment group,3 cases of rotator cuff injury,1 case of SLAP injury and 1 case of glenoid lip injury were found during the operation.At the last follow-up,two patients in the three bundle reconstruction group had slight loss of reduction,and no patients required removal of internal fixation because of discomfort.In the hook plate group,5 patients complained of shoulder movement discomfort and limited function after operation,and voluntarily asked for removal of internal fixation.At the last follow-up,3 patients suffered from slight loss of reduction,4 patients suffered from subacromial osteolysis accompanied by acromial impingement pain,and shoulder joint lift limitation.At the last follow-up,there were significant differences in Constant-Murley score and Karlsson score between the two groups(P<0.05).Conclusions For patients with acromioclavicular joint dislocation,arthroscopically assisted loop plate-suture combined with three-bundle reconstruction for acromioclavicular ligament repair is superior to hook plate in shoulder joint function recovery and pain relief after operation,and the performance of reduction and maintenance is affirmative.With the aid of shoulder arthroscopy,it is helpful to thoroughly investigate the complications of rotator cuff and labrum injury during operation.It is an effective method to treat Rockwood type III-V fresh acromioclavicular joint dislocation.