改良的双束固定技术治疗急性肩锁关节脱位的疗效分析  

Effect of a modified double-bundle fixation technique in the treatment of acute acromioclavicular joint dislocation

作　　者：刘一军 郭标[1] 马炜 杨东强[1] 付鹏飞 崔红林 LIU Yi-jun;GUO Biao;MA Wei;YANG Dong-qiang;FU Peng-fei;CUI Hong-lin(Department of Orthopedics,Fuyang People's Hospital Afiliated to Anhui Medical University,Fuyang,Anhui,236000,China)

机构地区：[1]安徽医科大学附属阜阳人民医院骨科,阜阳236000

出　　处：《中国骨与关节杂志》2024年第11期908-915,共8页Chinese Journal of Bone and Joint

基　　金：安徽省阜阳市第九批市级产业创新团队项目。

摘　　要：目的观察细骨道结合改良的Nice结双束固定技术治疗RockwoodⅢB级及以上的急性肩锁关节脱位的临床效果及放射学结果,评估其垂直方向和水平方向的稳定性。方法回顾分析28例急性RockwoodⅢB级到Ⅴ级肩锁关节脱位的患者(男19例,女9例),所有患者均使用细骨道结合改良的Nice结双束固定技术重建喙锁韧带。手术时患者年龄28~54岁,平均(42.7±8.7)岁。所有患者均进行了双侧对比的正位X线片及交胸内收位片拍摄,测量喙锁间距(CC间距)及肩锁间前后向的水平距离(AC间距),并进行了肩关节Constant评分、美国肩肘外科评分(American Shoulder and Elbow Surgeons’Form,ASES)及视觉模拟评分(visual analogue scale,VAS)。评估时间分别为术前、术后第1天、1个月、3个月、6个月、1年及以后每年。同时记录评估术后感染、复发脱位、内植物松动和医源性骨折等并发症。结果随访12~24个月,平均18个月。患肩末次随访Constant评分85~98分,平均(94.50±2.87)分,ASES评分85~97分,平均(92.68±3.36)分,较术前明显改善(P<0.05),与健侧肩关节Constant评分(95.07±2.55)分,ASES评分(93.64±3.00)分相比,差异无统计学意义(P>0.05)。在末次随访时,CC间距由术前的(15.20±3.81)mm减低到(7.33±2.11)mm(P<0.05),肩锁关节AC间距,由术前的(15.49±2.81)mm减少到末次随访时的(6.82±1.40)mm(P<0.05),与健侧肩关节相比,差异无统计学意义(P>0.05)。本组28例未见到脱位复发、感染、内植物松动、喙突骨折或锁骨骨折等并发症,所有患者均报告对术后恢复满意。结论细骨道结合改良的Nice结双束固定技术治疗急性高度肩锁关节脱位,可以获得垂直与水平方向的稳定性及良好的短期临床效果,且不会明显增加并发症的发生。Objective To observe the clinical results and radiographic findings of the fine bone channel combined with the modified nice knot double-bundle fixation in the treatment of acute acromioclavicular joint dislocations of Rockwood grade ⅢB and above,and to assess its stability in the vertical and horizontal directions.Methods Twenty-eight patients(19 males,9 females)with acute Rockwood grade ⅢB to gradeⅤacromioclavicular dislocations were retrospectively analyzed.All had rostral clavicular ligament reconstruction using a fine bone channel combined with modified nice knot double-bundle fixation.The mean age of the patients at the time of surgery was(42.7±8.7)years(range:28-54 years).All patients took bilateral contrast AP radiographs and cross-thoracic medial retraction films.The vertical distance between the rostral and clavicle(CC distance)and the anteroposteriorly oriented horizontal distance between the acromion and clavicle(AC distance)were measured.The shoulder Constant score,American Shoulder and Elbow Surgeons’Form(ASES)and VAS scores were recorded.Evaluations were performed preoperatively,1,3,6,12 months postoperatively,and annually thereafter.Complications such as postoperative infection,recurrent dislocation,implant loosening and medically induced fracture were also recorded and evaluated.Results At a mean follow-up of 18 months(range:12-24 months),the results showed that the mean Constant score of the affected shoulder at the last follow-up was(94.50±2.87)(range:85-98)and the mean ASES score was(92.68±3.36)(range:85-97),which were significant improved compared with the preoperative data(P<0.05);and there was no statistically significant difference when compared with that of the healthy shoulder(Constant score 95.07±2.55,ASES score 93.64±3.00)(P>0.05).At the final follow-up,the rostral-clavicular distance(CC distance)decreased from(15.20±3.81)mm preoperatively to(7.33±2.11)mm(P<0.05),and the horizontally anterior-posterior distance of the acromioclavicular joint(AC distance)decreased from(15

关 键 词：肩锁关节 关节脱位 韧带 关节 肩损伤 Nice结 

分 类 号：R684.7[医药卫生—骨科学]