喙肩韧带内侧半转位重建喙锁韧带治疗肩锁关节完全脱位  

Treatment of complete acromioclavicular joint dislocation with transfer of the medial half of the coracoacromial ligament to reconstruct the coracoclavicular ligament

作　　者：董文伟[1] 史增元[1] 刘振新[1] 毛海蛟[1] 

机构地区：[1]宁波大学医学院附属医院骨科,浙江宁波315000

出　　处：《中国骨伤》2015年第4期340-344,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的：探讨喙肩韧带内侧半转位重建喙锁韧带治疗肩锁关节完全脱位的手术方法和疗效。方法：2006年1月至2012年6月,采用喙肩韧带内侧半转位重建喙锁韧带,同时辅以锁骨钩钢板和克氏针内固定治疗肩锁关节完全脱位26例,男18例,女8例;年龄25～51岁,平均36.7岁;手术时间为伤后3～12 d,平均5 d.按照Rockwood分型：Ⅲ型4例,Ⅴ型22例。临床表现为局部肿胀、压痛伴弹跳感,肩关节活动受限,术前拍摄双侧肩关节标准应力位X线片,测量患侧喙锁间隙为（16.2±5.0） mm,较健侧（7.6±1.0） mm明显增宽。术后通过X线片检查和Constant-Murley评分对手术疗效进行评价。结果：术后切口均Ⅰ期愈合,无感染、内固定断裂、再脱位的发生。所有患者获得随访,时间12～30个月,平均18个月。于术后1个月拔除克氏针、8～10个月取出内固定钢板。到末次随访时肩关节活动均基本恢复正常,而且获得了一个无痛的关节。按Constant-Murley评分,优24例,良2例。喙锁间隙距离患侧为（7.7±1.2） mm,健侧为（7.6±1.0） mm,两侧比较差异无统计学意义（P〉0.05）.结论：采用喙肩韧带内侧半转位重建喙锁韧带,加喙锁韧带缝合、锁骨钩钢板和克氏针内固定综合治疗,效果良好。Objective：To explore the operation methods and clinical effects of transfer of the medial half of the coracoacromial ligament to reconstruct the coracoclavicular ligament in treating complete acromioclavicular joint dislocation. Methods：From January 2006 to June 2012, 26 patients with acute complete acromioclavicular joint dislocation underwent surgery. Transfer of the medial half of the coracoacromial ligament to reconstruct the coracoclavicular ligament, additional clavical hoot plate and Kirschner wires fixation, were performed in all the patients. Among the patients, 18 patients were male and 8 patients were female, with an average age of 36.7 years old （ranged from 25 to 51 years）. The duration from injury to operation was from 3 to 12 days with an average of 5 days. According to the Rockwood classification, 4 cases were grade Ⅲ and 22 cases were grade Ⅴ.Clinical manifestation included local swelling, tenderness with snapping, limitation of shoulder joint motion. In preoperative bilateral shoulder joint X-rays, the injured coracoclavicular distance was（16.2±5.0） mm which was significantly wider than that of uninjured sides （7.6±1.0） mm. Clinical results were evaluated according to X-rays and Constant-Murley score. Results：All incisions obtained primary healing after operation without complication of infection, internal fixation breakage, redislocation. All the patients were followed up from 12 to 30 months with an average of 18 months. Kirschner wires and internal fixation plate were removed at 1 month and 8-10 months after operation, respectively. At final follow-up, the motion of shoulder joint recovered to normal and a no pain joint was obtained. According to Constant-Murley score, 24 cases got excellent results and 2 cases good. There was no significant difference after operation between the injured coracoclavicular distance and the uninjured contralateral side [（7.7±1.2） mm vs （7.6±1.0） mm）, P〉0.05]. Conclusion：Transfer of the medial half of the coracoacromial lig

关 键 词：肩锁关节 脱位 喙肩韧带 喙锁韧带 

分 类 号：R684.7[医药卫生—骨科学]