锁骨远端切除联合腱外侧半反转辅助异体肌腱移植重建喙锁韧带治疗肩锁关节脱位  

Reconstruction of coracoclavicular ligament by excision and semi-inversion of conjoined tendon at the distal clavicle and allograft tendon transfer for treatment of acromioclavicular separation

作　　者：孙策勇 朱以明[2] 李奉龙[2] 姜春岩[2] 彭明学 王自鸿 

机构地区：[1]北京怀柔医院骨科,101400 [2]北京积水潭医院运动损伤科

出　　处：《中华创伤骨科杂志》2015年第7期553-558,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨锁骨远端切除联合腱外侧半反转辅助异体肌腱移植重建喙锁韧带治疗肩锁关节脱位的术后中长期疗效。方法回顾性分析2006年1月至2008年1月间采用锁骨远端切除联合腱外侧半反转辅助异体肌腱移植重建喙锁韧带手术治疗的54例肩锁关节脱位患者资料，男34例，女20例；年龄21．7～64．1岁，平均40．4岁。受伤至手术时间平均为12．2d（3—20d）。肩锁关节脱位按R。。kwood分型：Ⅲ型6例，Ⅳ型6例，Ⅴ型42例。末次随访时采用疼痛视觉模拟评分（VAS）、美国肩肘外科医师评分（ASES）评分及Constant．Mudey评分评价患者肩关节功能，同时摄肩关节X线片以评估肩锁关节复位是否丢失。结果术后54例患者平均随访64．2个月（48．6—92．2个月）。末次随访时患者肩关节前屈上举平均为170．0°（160°～180°），体侧外旋为57．8°（40°～80°），内旋至T8水平（B—T]2）。VAS评分平均为0．7分（0～4分），平均ASES评分为90．4分（81．7—100．0分），Constant—Murley评分平均为90．9分（83．0～100．0分）。12例（22．2％）患者出现肩锁关节压痛；6例（11．1％）V型损伤患者出现部分复位丢失；无一例患者出现完全复位丢失。结论采用锁骨远端切除联合腱外侧半反转辅助异体肌腱移植重建喙锁韧带的方法治疗重度肩锁关节脱位，患者的肩关节功能恢复满意，中长期疗效较好，多数患者肩锁关节保持稳定。Objective To investigate the mid- and long-term outcomes of reconstruction of eoraeo- clavicular ligament by excision and semi-inversion of conjoined tendon at the distal clavicle and allograft tendon transfer in the treatment of acromioclavicular separation. Methods From January 2006 to January 2008, 54 patients with acromioclavicular separation were treated by reconstruction of coracoclavicular ligament by excision and semi-inversion of conjoined tendon at the distal clavicle and allograft tendon transfer. They were 34 men and 20 women, with a mean age of 40. 4 years （range, from 21.7 to 64. 1 years） . The mean time from injury to surgery was 12. 2 days （range, from 3 to 20 days）. According the Rockwood classification, 6 cases were type m, 6 type 1V and 42 type V. All the patients were routinely followed up after the surgery. The visual analogue scale （VAS）, American Shoulder and Elbow Surgeons （ASES） and Constant-Murley scores were used to evaluate the postoperative shoulder function. Postoperative radiograph was taken for each patient to evaluate the loss of reduction of the acromioclavicular joint. Results The mean follow-up time was 64. 2 months （range, from 48.6 to 92.2 months）. At the final follow-up, the average forward elevation was 170.0~ （range, from 160~ to 180~）, external rotation 57.8~ （range, from 40~ to 80~） and internal rotation T8 level （range, from T2 to T12）, respectively. The average VAS, ASES and Constant-Murley scores were 0.7 （range, from 0 to 4）, 90. 4 （range, from 81.7 to 100. 0） and 90.9 （range, from 83.0 to 100. 0）, respec- tively. Tenderness on the distal clavicle was found in 12 patients （22.2%）. Partial loss of reduction was found in 6 patients with type V fracture （ 11.1% ）. No complete loss of reduction was found in any case. Conclusion Most patients may obtain good shoulder function and no loss of reduction at mid- and long-term follow-ups after their acromioclavicular separation has been treated by reconstruction of coracoclav

关 键 词：肩锁关节脱位 修复外科手术 移植 同种异体 

分 类 号：R687.3[医药卫生—骨科学]