联合腱外侧半肌腱反转移位重建喙锁韧带治疗RockwoodⅢ～Ⅳ型肩锁关节脱位  

Proximally based conjoined tendon transfer for coracoclavicular ligament reconstruction in treatment of Rockwood grades Ⅲ-Ⅳ acromioclavicular joint dislocation

作　　者：曾明[1] 付士平 夏荣刚[2] 

机构地区：[1]上海市第八人民医院骨科,200235 [2]上海市第六人民医院骨科

出　　处：《中华创伤杂志》2017年第3期253-257,共5页Chinese Journal of Trauma

摘　　要：目的探讨经改良联合腱外侧半肌腱反转移位重建喙锁韧带治疗RockwoodⅢ-Ⅳ型肩锁关节脱位的疗效。方法采用回顾性病例对照研究分析2007年10月-2014年8月肩锁关节脱位患者64例，其中男53例，女11例；年龄23—65岁[（43．75±10．47）岁]。骨折按照Rockwood分型：Ⅲ型27例，Ⅳ型37例。根据手术方法分为韧带重建组（行喙锁韧带重建结合锁骨钩钢板治疗术，26例）和内固定组（行锁骨钩钢板治疗术，38例）。比较两组术前、术后3个月视觉模拟评分（VAS），以及两组患侧肩关节Constant评分及术后并发症发生情况。结果患者均获随访2—4个月，平均3．7个月。韧带重建组、内固定组术前VAS分别为（7．58±1．03）分和（7．15±1．03）分（P〉0．05），术后3个月分别为（2．38±0．94）分和（2．08±0．99）分（P〉0．05）。韧带重建组、内固定组Constant评分分别为（86．46±6．59）分和（87．68±6．59）分（P〉0．05）。内固定组出现6例复发脱位，复发率为16％；韧带重建组未出现复发患者，复发率为0％（P〈0．05）。结论应用改良联合腱外侧半反转移位重建喙锁韧带可降低肩锁关节脱位的复发率。Objective To evaluate the curative effect of conjoined tendon transfer for coracoclavicular ligament reconstruction in the treatment of Rockwood grades Ⅲ～Ⅳ acromioclavicular joint dislocation, c Methods A retrospective case control study was performed for 64 cases of acromioclavicular joint dislocation admitted from October 2007 to August 2014. There were 53 males and 11 females, with age of （ 43.8± 10.5 ） years （ range, 23 to 65 years）. Rockwood grade m was seen in 27 cases and grade - Ⅳ in 37. According to the treatments, 26 cases underwent proximally based conjoined tendon transfer for coracoclavicular ligament reconstruction combined with clavicular hook plate （ligament reconstruction group） and 38 cases only treated with clavicular hook plate （internal fixation group）. Visual analogue scale （VAS） , Constant shoulder score and postoperative complications were compared between the two groups before and after operation. Results All patients were available for a mean follow-up of 3.7 months （ range, 2 to 4 months）. VAS was （7.58 ± 1.03） points in ligament reconstruction group and （7. 15 ± 1.03）points in internal fixation group before surgery （P 〉0.05）, and was （2.38 ±0. 94）points in ligament reconstruction group and （2.08 ± 0.99 ） points in internal fixation group 3 months after operation （ P 〉 0.05 ）. Constant shoulder score was （ 86.46 ± 6.59 ） points in ligament reconstruction group and （87.68 ± 6.59） points in internal fixation group after operation （ P 〉0. 05 ）. Six cases （ 16% ） had recurrent joint dislocation in internal fixation group, while none of the patients in ligament reconstruction group had recurrence （ P 〈 0. 05 ）. Conclusion Improved procedure of proximally based conjoined tendon transfer for coracoclavicular ligament reconstruction can effectively reduce the recurrence rate of acromioclavicular joint dislocation.

关 键 词：肩锁关节 脱位 骨折固定术 内 

分 类 号：R687.4[医药卫生—骨科学]