喙突基底小切口TightRope固定治疗新鲜肩锁关节脱位  

Treatment of dislocation of acromioclavicular joint with TightRope fixation through a small incision in the base of coracoid process

作　　者：沈杰枫[1] 朱义用[1] 严松鹤[1] 刘勇[1] 华臻[1] SHEN Jie-feng;ZHU Yi-yong;YAN Song-he;LIU Yong;HUA Zhen(Department of Traumatology,Wuxi Traditional Chinese Medicine Hospital,Wuxi 214000,Jiangsu,China)

机构地区：[1]无锡市中医医院骨伤科,江苏无锡214000

出　　处：《中国骨伤》2020年第8期707-711,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨小切口TightRope固定治疗新鲜肩锁关节脱位的方法与疗效。方法:2016年1至2018年5月收治新鲜肩锁关节脱位28例,男20例,女8例;年龄26~87岁,平均51.3岁。改良Rockwood分型:Ⅱ型1例,Ⅲ型22例,Ⅴ型4例。受伤至手术时间为0~6 d,平均2.4 d。记录手术时间、肩功能恢复时间、术后并发症情况;评估术后即刻复位效果及末次随访肩关节Karlsson功能,以SPSS 20.0软件Pearson分析二者相关性。结果:28例患者1例RockwoodⅡ型仅重建锥状韧带,其余27例重建锥状韧带和斜方韧带。手术时间(66.50±12.62) min(含术中透视时间)。28例均获得随访,时间11~20(16.7±4.6)个月。患者术后肩功能恢复时间为2~7个月,平均4个月。随访期内,1例患者锁骨钢板部位发生骨溶解及复位丢失;其余未出现再脱位、纽扣钢板脱出等并发症。术后即刻复位效果:复位不足6例,完全复位17例,复位过度5例;末次随访肩关节Karlsson功能评价:优21例,良6例,差1例;Pearson分析r=0.060提示新鲜肩锁关节脱位手术即刻复位效果与末次随访患肩关节Karlsson功能评价无明显相关性。结论:经喙突基底小切口行TightRope固定治疗新鲜肩锁关节脱位操作简便,可以早期功能锻炼,患者功能恢复优良。新鲜肩锁关节脱位手术即刻复位效果5 mm以内的轻微差异与术后末次随访患肩关节Karlsson功能评价无明显相关性。临床随访建议关注复位丢失以及锁骨钢板部位骨溶解。Objective:To explore the method and effect of small incision TightRope fixation in the treatment of fresh acromioclavicular joint dislocation. Methods:From January 2016 to May 2018,28 cases of fresh acromioclavicular dislocation were treated,including 20 males and 8 females,aged 26 to 87 years with an average age of 51.3 years. The modified Rockwood classification included 1 case of typeⅡ,22 cases of type Ⅲ and 4 cases of type V. The average time from injury to operation was2.4 days. The operative time,shoulder function recovery time and postoperative complications were recorded,and the immediate reduction effect and Karlsson function of shoulder joint were evaluated. Results:In 28 patients,only one Rockwood type Ⅱ was used to reconstruct the pyramidal ligament,and the other 27 were used to reconstruct the pyramidal ligament and the trapezoid ligament. The average operation time was(66.50±12.62) min(including intraoperative fluoroscopy time). Twenty eight cases were followed up for 11 to 20(16.7±4.6) months. The recovery time of shoulder function was 2 to 7 months with an average of 4 months. During the follow up period,1 case had osteolysis and loss of reduction at the clavicular plate site,and the rest had no complications such as re dislocation and button plate prolapse. Immediate reduction effect after operation :6 cases with reduction insufficiency,17 cases with complete reduction and 5 cases with excessive reduction;Karlsson function evaluation of shoulder joint in the last follow up:excellent in 21 cases,good in 6 cases and poor in 1 case;Pearson analysis r=0.060,suggesting that the immediate reduction effect of fresh acromioclavicular dislocation operation has no significant correlation with Karlsson function evaluation of shoulder joint in the last follow up. Conclusion:TightRope fixation through a small incision in the base of coracoid process is a simple and effective method for the treatment of dislocation of acromioclavicular joint. There was no significant correlation between the slight diff

关 键 词：肩锁关节 肩脱位 最小侵入性外科手术 

分 类 号：R684.7[医药卫生—骨科学]