TightRope治疗RockwoodⅢ型肩锁关节脱位失败病例分析  

Failure cases analysis of TightRope in the treatment of Rockwood type Ⅲ acromioclavicular dislocation

作　　者：王秀会[1] 崔煦 王明辉[1] 崔崟 付备刚 孙泽毅 蔡攀 苏日宝 Wang Xiuhui;Cui Xv;Wang Mignhui;Cui Yin;Fu Beigang;Sun Zeyi;Cai Pan;Su Ribao(Department of Orthopedics,Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences,Shanghai 201318,China)

机构地区：[1]上海健康医学院附属周浦医院骨科,201318

出　　处：《中华肩肘外科电子杂志》2019年第1期44-49,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：上海市浦东新区卫生和计划生育委员会临床特色学科建设资助(PWYts-2018-02);上海市浦东新区卫生和计划生育委员会科技发展专项基金资助(PW2016A-21);上海市浦东新区卫生系统重点学科群建设资助(PWZxq2017-12);上海健康医学院种子基金项目(SFP-18-22-17-001)

摘　　要：目的分析TightRope治疗肩锁关节脱位失败病例的原因,总结相关经验教训。方法自2014年1月至2018年4月收治肩锁关节脱位RockwoodⅢ型77例,均采用TightRope重建喙锁韧带治疗,术后发生钢板脱出、松动共6例,分析其手术失败原因。结果所有患者均获随访,随访时间3～32个月,平均14.30个月,术后3个月Constant评分(93.86±5.59)分。失败病例6例,术后3个月Constant评分(79.17±7.33)分。失败原因包括隧道建立偏斜3例,手术操作不当2例,肩锁关节过度复位1例。结论 TightRope治疗肩锁关节脱位导致失败的因素:严重的骨质疏松,隧道建立偏斜,过度复位等。Background Acromioclavicular dislocation is a common clinical injury.Conservative treatment is usually applied for Rockwood types Ⅰ and Ⅱ,while Rockwood types Ⅲ-Ⅴ are mainly treated with clavicular hook plate or button plate.Although clavicular hook plate is simple to operate,there are some complications that are difficult to overcome.Moreover,the removal of plate is required.TightRope overcomes many drawbacks of clavicular hook plate and is minimally invasive.Thus,this strategy is widely used.However,the button plate treatment of acromioclavicular joint dislocation requires higher technique.Furthermore,there will also be some complications.Methods 1.The Object of Study:From January 2014 to April 2018,77 cases of Rockwood type Ⅲ acromioclavicular joint dislocation were treated with TightRope(Arthrex,USA)button plate,including 54 males and 23 females.The age ranged from 20 to 72 years with an average of 48.31 years.As all cases are unilateral,35 cases had the right side affected,and 42 cases had the left side affected.Among them,there were 16 cases of traffic injury and 61 cases of falling injury,and all the dislocations were fresh.All patients were diagnosed by shoulder X-ray,and the main physical examination was positive.The time from injury to operation ranged from 3 to 144 hours.6 cases failed.2.Operative Method:The patient was in supine position with shoulder pad under the affected side.An 2-4cm incision was made transversely on lateral clavicle above corocoid.The skin,subcutaneous,deep fascia and platysma cervicalis were cut open layer by layer,and a small amount of deltoid clavicle attachment was dissected to reveal the lateral segment of clavicle and the coracoclavicular ligament.A 2.0 mm guide needle was used to drill through clavicular shaft to the base of coracoid process.After satisfactory position was confirmed with C-arm fluoroscopy,a 4.0 mm hollow drilling was used to build the tunnel of clavicle and coracoid.TightRope rectangular buttons were penetrated through the skeletal tunnels with t

关 键 词：TIGHTROPE 肩锁关节 脱位 失败 Constant评分 

分 类 号：R687.4[医药卫生—骨科学]