TightRope重建喙锁韧带联合锚钉治疗肩锁关节脱位的临床疗效  

Clinical efficacy of reconstruction of coracoclavicular ligament by Tight Rope and reparation of acromioclavicular joint by suture anchor in the treatment of dislocation of acromioclavicular joint

作　　者：李想[1] 张峰[1] 丁真奇[1] 叶永贤 黄剑平[1] 黄国锋[1] LI Xiang;ZHANG Feng;DING Zhenqi;YE Yongxian;HUANG Jianping;HUANG Guofeng(Department of Orthopaedics, the 175th Hospital of PLA, Zhangzhou 363000, China)

机构地区：[1]中国人民解放军第一七五医院骨科,福建漳州363000

出　　处：《骨科》2017年第1期25-29,共5页ORTHOPAEDICS

基　　金：国家自然科学基金(81371951;81401783)

摘　　要：目的探讨Tight Rope重建喙锁韧带联合锚钉修复肩锁关节治疗肩锁关节脱位的疗效。方法回顾性分析2013年5月至2015年5月于我院采用Tight Rope重建喙锁韧带联合锚钉修复肩锁关节治疗的13例肩锁关节脱位病人(Tight Rope+锚钉组)及采用肩锁钩钢板治疗的21例肩锁关节脱位病人(肩锁钩钢板组)的临床资料,比较两组的手术时间、术中出血量、术后及末次随访时的X线片及术后3、6个月及末次随访时的Neer肩关节功能评分。结果两组的手术时间、术中出血量比较,差异均无统计学意义(均P>0.05)。在术后3、6个月及末次随访时,Tight Rope+锚钉组的Neer肩关节功能评分分别为(84.5±8.1)分、(91.8±9.4)分、(96.1±11.1)分,而肩锁钩钢板组的相应得分分别为(72.4±7.5)分、(86.9±9.6)分、(89.2±9.8)分,Tight Rope+锚钉组明显优于肩锁钩钢板组,差异均有统计学意义(均P<0.05)。末次随访时的X线片提示Tight Rope+锚钉组病人无复位丢失、创伤性关节炎等出现;肩锁钩钢板组出现4例肩峰下撞击征,1例肩峰骨溶解,所有病人均在8~10个月后取出内固定,2例病人取出钢板后出现复位丢失。结论采用Tight Rope重建喙锁韧带联合锚钉修复肩锁关节治疗肩锁关节脱位,可获得更符合生物力学的复位,肩锁关节稳定,肩关节功能恢复满意,无需二次手术取出内固定。Objective To investigate the clinical effects of reconstructing the coracoclavicular liga?ment by TightRope and repairing the acromioclavicular joint by suture anchor in the treatment of acromiocla?vicular joint dislocation. Methods From May 2013 to May 2015, the clinical data of 21 patients with acromio?clavicular separation who were treated by hook plate fixation (hook plate group) and those of other 13 patientstreated by TightRope with suture anchor (TightRope + suture anchor group) were retrospectively analyzed. Theoperating time, intraoperative blood loss, postoperative and the final follow?up radiograph, and the Neer score ofshoulder joint were compared between two groups. Results There was no statistically significant difference inoperating time and intraoperative blood loss between two groups (P>0.05). The Neer scores of shoulder joint inTightRope + suture anchor group at 3rd and 6th month after operation and the final follow?up were 84.5±8.1,91.8±9.4, 96.1±11.1 respectively, significantly higher than in the hook plate group correspondingly (72.4±7.5,86.9±9.6 and 89.2±9.8 respectively) (P>0.05 for all). There was no loss of reduction and tenderness onacromioclavicular joint in the TightRope + suture anchor group at the final follow?up. In the hook plategroup, 4 patients suffered subacromial impingement syndrome and osteolysis of acromion was found in 1patient, all internal fixators were removed after 8?10 months, and 2 patients took out the loss after removal ofthe plate. Conclusion Coracoclavicular ligament reconstruction by TightRope with acromioclavicular repara?tion by suture anchor in the treatment of acromioclavicular joint dislocation could obtain better biomechanical reduction, stable shoulder joint and satisfactory shoulder function.

关 键 词：肩锁关节脱位 喙锁韧带 TIGHTROPE 缝合锚 

分 类 号：R687.4[医药卫生—骨科学]