关节镜辅助下三束重建治疗急性Rockwood Ⅲ 型肩锁关节脱位  

Arthroscopically-assisted triple bundles reconstruction for treatment of Rockwood type Ⅲ acute acromioclavicular joint separations

作　　者：何继业[1] 张家红[1] 蔡贵泉[1] 王晖[1] 王栋梁[1] He Jiye;Zhang Jiahong;Cai Guiquan;Wang Hui;Wang Dongliang(Department of Orthopedics,Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院骨科

出　　处：《中华肩肘外科电子杂志》2019年第4期294-300,共7页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：上海市科委课题(13DZ1940704)

摘　　要：目的探讨关节镜辅助下三束重建治疗急性RockwoodⅢ型肩锁关节脱位的临床疗效。方法回顾性分析上海交通大学医学院附属新华医院骨科采用关节镜辅助下三束重建治疗21例急性RockwoodⅢ型肩锁关节脱位患者的资料,均为闭合性损伤。术后3、6、12个月对所有患者进行术后临床效果和影像学评价。根据术后影像学资料评估复位再丢失情况,采用Constant评分和上肢功能(disabilities of arm,shoulder and hand,DASH)评分评估患者肩关节功能。探讨术中关节镜辅助治疗的意义和价值。结果术中关节镜探查发现4例合并软组织损伤,并进行一期镜下修复。所有患者术后均未发生喙突骨折和襻断裂。影像学评估提示术后6~12个月有6例患者(28.6%)出现轻度复位丢失,但与Constant评分和DASH评分无显著相关性,没有患者要求取出内固定。结论关节镜辅助下三束重建治疗急性RockwoodⅢ型肩锁关节脱位是一种创伤小、安全、临床效果确切的手术方法。急性肩锁关节脱位通常由高能量损伤造成,在手术中关节镜探查肩关节能发现合并的软组织损伤,并进行一期修复,有利于肩关节功能的恢复,避免二次手术。Background Acromioclavicular joint dislocation is a common shoulder joint injury,which is very common in traffic accidents and contact sports,and there are far more male patients than females.The gold standard for the treatment of acromioclavicular joint dislocation of Rockwood type III has been controversial.Many studies have suggested that Rockwood type III acromioclavicular joint dislocation can achieve better clinical result after conservative treatment,but some studies have found that there are still persistent pain and dysfunction in conservative treatment.Some authors advocate surgical treatment of type III acromioclavicular joint dislocation in young and active patients to restore normal shoulder function.Recent studies have shown that a controlled study of Rockwood type III patients has found that surgical treatment has better function and appearance than conservative treatment.Currently,commonly used hook plate for the treatment of Rockwood type III acromioclavicular joint dislocation,postoperative complications including pain,acromion erosion,subacromial impingement,and the need for secondary surgery to remove implants.Some doctors have achieved good results with Endobutton single-bundle reconstruction.Studies have shown that acromioclavicular joint dislocation often associated with other soft tissue injuries of the shoulder joint.At present,there is no relevant research report on the clinical efficacy of triple bundles reconstruction(cone ligament,oblique ligament,acromioclavicular ligament)assisted by arthroscopy in the treatment of acute Rockwood type III acromioclavicular joint dislocation.Methods 1.General information:This study was included from January 2014 to March 2017.We used triple bundles reconstruction assisted by arthroscopy to treat 21 patients with Rockwood type III acromioclavicular joint dislocation.There were 15 males and 6 females,aged 25-56,mean(34.70±7.25)years old.Causes of injury:12 cases of traffic injuries,5 cases of falls,4 cases of sports injuries.The time from injury to su

关 键 词：肩锁关节脱位 关节镜 三束重建 RockwoodⅢ型 

分 类 号：R68[医药卫生—骨科学]