应用LARS人工韧带治疗急性肩锁关节脱位的初步报告  

The treatment of the acute acromioclavicular joint dislocation with LARS artificial ligament:a preliminary report

作　　者：陈爱民[1] 鹿楠[1] 叶添文[1] 杨鹏[1] 朱磊[1] 李菁[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200003

出　　处：《中华肩肘外科电子杂志》2014年第1期20-24,共5页Chinese Journal of Shoulder and Elbow(Electronic Edition)

摘　　要：目的：评价通过 LARS人工韧带重建并加强喙锁韧带的方法治疗肩锁关节脱位的临床效果。方法应用 LARS人工韧带重建喙锁韧带治疗8例 Tossy Ⅲ型肩锁关节脱位,其中男性5例,女性3例；年龄21~45岁；左肩3例,右肩5例。致伤原因：摔倒7例,车祸1例。临床评价采用Constant评分和 VAS评分。采用双侧肩锁关节的Zanca位片和患侧肩关节腋位片进行影像学评价。结果所有患者获得平均24(5~40)个月的随访。8例肩锁关节脱位均获得复位,肩关节 Constant评分从术前的(59.3±6.9)分提高到(96.5±9.3)分(t=300,P<0.05)。VAS评分从术前的(5.4±1.3)分下降到(0.7±0.9)分(t=300,P <0.05)。术后 X 线片显示7例患者获得了解剖复位,有1例复位轻度丢失。发现2例喙锁韧带钙化,1例肩锁关节退变,未发现挤压螺钉周围骨溶解。结论应用 LARS人工韧带进行喙锁韧带重建可以为肩锁关节提供可靠的初期强度,并允许患者早期进行功能锻炼,可以使患者得到较好的临床疗效,而且并发症少。Background Currently,the clinical perspectives of surgical treatment for Tossy Ⅲacromioclavicular(AC)joint dislocations are relatively identical.Due to the post-traumatic ruptures of the acromioclavicular ligament and coracoclavicular(CC)ligament which are used to maintain stability of the joint,the clavicle moves backward and upward,and the upper arm and the scapula drops downward for the gravity of the upper arm and the influence of the sternocleidomastoid muscle.Since such complications as reduction difficulties,redislocation after external fixation,pressure ulcers of the skin,and so forth are particularly prone to occur in the conservative therapy,the operative treatment is more inclined to be adopted for the Tossy Ⅲ dislocation of the AC joint.With the single repair and fixation of the CC ligament,redislocation is likely to happen after implant removal because the ruptured ligaments healed as scar tissue.Therefore,this study uses an operative method of reconstructing and augmenting the CC ligament with LARS artificial ligament for the treatment of Tossy Ⅲ AC joint dislocation,and evaluates its clinical effect.Methods From November 2006 to July 2009,8 patients with acute AC joint dislocation of Tossy Ⅲ were admitted into our hospital.Five patients were male and 3 were female,and their ages ranged from 21 to 45.Sides:3 injuries were on the left and 5 were on the right.Seven patients suffered from falling on the ground,and 1 patient was inj ured in a traffic accident.All the patients were treated with LARS artificial ligaments to reconstruct the CC ligament.Constant score and VAS score were adopted in clinical evaluation.Zanca view of the bilateral AC joint and the axillary radiograph of the affected shoulder joint were employed for imaging evaluation.All the patients were simple Tossy Ⅲ dislocation of AC joint with no trauma of other parts and skin breakdown.Regular pre-operative examinations and evaluations were carried out after admission,and LARS artificial ligament was used to reconstruct the CC

关 键 词：肩锁关节 脱位 喙锁固定 LARS人工韧带 

分 类 号：R687.3[医药卫生—骨科学] R687.2[医药卫生—外科学]