带襻钢板结合自体肌腱移植重建喙锁韧带治疗陈旧性肩锁关节脱位的近期临床疗效  

Double endobuttons combined with autogenic tendon transplantation for chronic acromioclavicular dislocation

作　　者：李剑[1] 赵阳[1] 王微[1] 李红川[1] 康汇[1] LI Jian ZHAO Yang WANG Wei LI Hong-chuan KANG Hui.(Department of Sports Medicine, Hong-Hui Hospital, Xi ＇an Jiaotong University College of Medicine, Xi ＇an, Shaanxi, 710054, PRC)

机构地区：[1]西安交通大学医学院附属红会医院运动医学科,710054

出　　处：《中国骨与关节杂志》2016年第9期653-656,共4页Chinese Journal of Bone and Joint

摘　　要：目的探讨带襻钢板结合自体肌腱移植重建喙锁韧带治疗陈旧性肩锁关节脱位的临床疗效。方法 2012年1月至2015年3月,我院采用带襻钢板结合肌腱移植重建喙锁韧带治疗12例陈旧性肩锁关节脱位患者。其中,男8例,女4例;年龄21-49岁,平均32岁。12例均为直接暴力致伤。Rockwood III型7例,IV型4例,V型1例。左侧7例,右侧5例。受伤至手术时间为2-17个月,平均7个月。对上述12例进行回顾性随访研究,采用VAS疼痛评分和Constant-Murley评分评估肩关节的疼痛及功能。肩关节在前屈、后伸、外展、内收、外旋、内旋的活动度亦被观察记录,并与健侧进行比较。结果 12例均获随访,平均12（6-18）个月。术后切口均I期愈合,肩锁关节脱位均获得纠正,无一例发生神经、血管损伤等并发症。随访期间,无一例发生再脱位。术后6个月肩关节Constant-Murley评分：（89.4±5.8）分,较术前（52.3±10.3）分,显著改善（P=0.003）,VAS疼痛评分（0.4±0.2）分,较术前（2.4±0.6）分,显著降低（P〈0.001）。随访终末时,患侧肩关节各方向的活动度与健侧相比差异无统计学意义。结论带襻钢板结合肌腱移植重建喙锁韧带,既提供了与原韧带相似的生物活性,又符合肩锁关节的生物力学,同时具有创伤小、操作简单、固定可靠、可早期功能锻炼等优点,是治疗陈旧性肩锁关节脱位的理想方法。Objective To investigate the results of double endobuttons combined with autogenic tendon transplantation for chronic acromioclavicular dislocation. Methods From January 2012 to March 2015, 12 cases of chronic acromioclavicular dislocation were admitted in our hospital. All patients underwent the treatment of double endobuttons combined with autogenic tendon transplantation. There were 8 males and 4 females, with the mean age of 32 years（ range： 21- 49 years）. All patients were caused by direct violence. There were 7 cases of Rockwood type III, 4 of type IV and 1 of type V. Seven cases were in the left, and 5 in the right. The duration from the injury to surgery was averagely 7 months（ range： 2- 17 months）. The Constant-Murley score was used to assess shoulder functions before and after the surgery. And visual analogue scale was used for pain grading. Range of motion（ flexion, extension, abduction, adduction, external rotation, internal rotation） was also measured. Results All patients have been followed up, with the mean time of 12 months（ range： 6- 18 months）. After the surgery, all dislocations got reduction and all wounds got one-stage healing. There were no cases of nerve or vessel complications. Till the end of the follow-up, there were no cases of re-dislocation. The Constant-Murley score increased significantly from（ 52.3 ± 10.3） points before the surgery to（ 89.4 ± 5.8） points after the surgery（ P = 0.003）. And the VAS pain score declined significantly from（ 2.4 ± 0.6） points before the surgery to（ 0.4 ± 0.2） points after the surgery（ P〈0.001）. However, there were no significant differences in range of motion in any direction after the surgery. Conclusions Our operation method provides similar biological activity like the original ligament and complies with the biomechanics of the acromioclavicular joint. At the same time, it has advantages of small trauma, simple operation, reliable fixation and earlier beginning of functional exercises. It is an ideal

关 键 词：肩锁关节 关节脱位 韧带 喙锁韧带 

分 类 号：R687.4[医药卫生—骨科学]