比较保守治疗与自体腓骨长肌腱前侧半（anterior half of the peroneus longus tendon, AHPLT）重建喙锁韧带治疗Rockwood Ⅲ型肩锁关节脱位的疗效。

自2013年6月至2016年3月共收治36例Rockwood Ⅲ型肩锁关节脱位患者。根据治疗方式不同将患者分为重建喙锁韧带组（利用自体AHPLT重建技术治疗）15例和保守治疗组21例。记录术前及术后（或保守治疗后）1、3、6、12个月的肩关节Constant、Quick DASH、VAS评分综合评估患者肩关节功能情况，并通过影像学分析复位是否丢失。

重建喙锁韧带组和保守组在随访1年时，患侧Constant评分分别为95.27分和97.02分，均较术前或保守治疗前Constant评分49.8分和51.8分显著提高，差异有统计学意义（P<0.05），重建组和保守组间Constant评分差异无统计学意义（P>0.05）。一年时Quick DASH评分重建组和保守组分别为6分和2.38分，均较术前或保守治疗前23.8分和16.15分显著降低（P<0.05），重建组和保守组间Quick DASH评分差异无统计学意义（P>0.05）。一年时VAS评分重建组和保守组分别为0.33分和0.10分，均较术前或保守治疗前4.73分和4.38分显著降低（P<0.05），重建组和保守组间VAS评分无统计学意义（P>0.05）。1个月时，重建组Constant评分43.4分，Quick DASH评分58分，VAS评分4.27分，疗效均较保守组Constant评分65.17分，Quick DASH评分36.19分，VAS评分2.48分差（P<0.05）。3个月时重建组与保守组Constant评分无明显差异，但保守组Quick DASH评分与VAS评分较重建组好（P<0.05）。6个月时，两组间Constant评分和Quick DASH评分差异无统计学意义（P>0.05），而VAS评分保守组较重建组更低，差异有统计学意义（P<0.05）。影像学检查提示随访1年时，重建组15例患者中有3例发生复位丢失（20%），保守组21例中发生复位丢失的有5例（23.81%）。重建组患者均无感染，锁骨、喙突骨折等并发症发生。

对于Rockwood Ⅲ型肩锁脱位患者，采用重建喙锁韧带治疗或者保守治疗均能达到较好的临床效果，在早期，采用保守治疗的患者其功能和疼痛优于重建韧带治疗的患者。

Due to the lack of consensus on the best treatment method for acromioclavicular joint injuries, there is still controversy at present. The anatomical structure of acromioclavicular joint seems simple, but more and more laboratory studies have found that the biomechanical relationship between clavicle and acromion is very complex and has not been fully studied. At the same time, a large number of literatures reported a variety of surgical treatment methods for acromioclavicular joint dislocation injuries. In addition, the epidemiological data about dislocation and injury of acromioclavicular joint may not be reliable. For example, we often quote that the incidence of joint damage caused by acromioclavicular joint dislocation is usually 9% or 12% of all shoulder joint injuries. However, the review of citations reveals that these percentages are from a book written by Cave in 1958 , which includes the analysis report of Row and Marble on 1,603 cases of scapular belt damage, among which the percentage of acromioclavicular joint injury is about 52 (3.2 %) . Although there are some errors in the calculation of this book, recent reports show that AC joint injury is one of the most common shoulder injuries among young athletes. Rockwood et al described two basic theories when choosing treatment scheme for patients with acromioclavicular joint dislocation injury: conservative or non-surgical treatment and surgical repair . Although the concept is simple, a large number of surgical techniques described in the current literature make it difficult for surgeons to identify which technique or method is the best for the treatment of specific acromioclavicular joint dislocation injuries. At the same time, there is still great controversy about whether to choose surgical treatment or conservative treatment for rockwoodⅢ patients. In addition, considerations about the timing of surgical intervention and reconstruction types need to be further studied, in order to formulate a relatively standardized treatment scheme, and to provide best effect for patients with acromioclavicular joint dislocation.Recently, the surgical technique of anatomical reconstruction of coracoid ligament has been increasingly applied to the treatment of acromioclavicular joint dislocation. it is common to use autogenous semitendinosus tendon, but it may cause nerve damage when tendon is taken, and the probability of symptoms of front-knee is higher after that . Zhao et al. reported the study of using the anterior half of the peroneal tendon (AHP LT) as the graft material, which was relatively simpler and safer in the process of tendon retrieval . However, there is little research on the reconstruction of coracoclavicular ligament with AHPLT as graft material.

General information:From June 2013 to March 2016, 41 patients of Rockwood type III acromioclavicular joint dislocation were divided into two groups according to the conservative treatment and the operation of coracoclavicular ligament reconstruction with AHPLT. AHPLT reconstruction group had 15 patients (13 males and 2 females) and their ages ranged from 22 to 68 years with an average (50.53±14.74) years. Conservative treatment group had 21 patients (16 males and 5 females) and their ages ranged from 25 to 61 years with an average of (45.95±10.38) years. There was no significant difference between the two groups in age and gender (P>0.05) . The AHPLT reconstruction was performed by an experienced senior surgeon. Inclusive and exclusive criteria:Inclusion criteria: (1) patients over 18 years without serious complications; (2) Rockwood type III acromioclavicular joint dislocation based on X-ray films of bilateral anteroposterior and axillary views; (3) coracoclavicular ligament rupture revealed on MR; (4) shoulder pain and limited mobility which affected normal life. Exclusion criteria: (1) patients below 18 years without serious complications; (2) combination of other injuries, such as clavicular fracture, coracoid fracture, etc.Treatment Methods: (1) AHPLT reconstruction group:General anesthesia was adopted, and patients took the " beach chair" position. Make a longitudinal incision about 2 cm at the posterior edge of the lateral malleolus. Separate and expose the peroneal longus tendon, and lift it out with mosquito forceps. The tendon was separated into two equal parts longitudinally by blade, and AHPLT was seamed with No.2 Ethibond su ture. Keep the foot flexed, disconnect AHPLT from the distal end, and remove the tendon to the proximal end with a 6 mm wide tendon extractor. Close the skin incision. After sewing the proximal end of AHPLT by locking the edge, 20 N of force was applied to it for 20 min pretension. Fold AHPLT into two shares. Take a 6-7 cm arc incision, extending from coracoid to clavicle and then to acromion. Cut the trapezius fascia from deltoid muscle to reveal the 1/3 lateral clavicle and acromioclavicular joint. Reposition the acromioclavicular joint. 35 mm from the lateral edge of clavicle, align with the base of coracoid process and drill into the guide pin from clavicle to coracoid process, and confirm that the guide pin passes through the center of the base of coracoid process under fluoroscopy. Drill a hole using a 4.5 hollow drill from the guide pin, drill through the clavicle and coracoid process, and then take a 6 mm diameter hollow drill to drill through the clavicle along the guide pin. A guide pin is drilled through the clavicle at the bottom of the coracoid process which is 17 mm away from the lateral edge of the clavicle, and then a 6 mm diameter hollow drill is used to drill through the clavicle along the guide pin. AHPLT was guided by ethibond suture to penetrate through the preset hole 35 mm from the lateral edge of clavicle, through the preset hole at the bottom of coracoid process, and then through the preset hole 17 mm from the lateral edge of clavicle. A 6 mm hydroxyapatite interface screw was fixed in the hole with graft 35 mm away from the lateral edge of clavicle, and the reconstructed ligament was tightened. then another 6 mm hydroxyapatite interface screw was fixed in the hole with graft 17 mm away from the lateral edge of clavicle. Sagittal and coronal fluoroscopy confirmed that the acromioclavicular joint was in good alignment. Flush and close the trapezius fascia, subcutaneous tissue and skin layer by layer. Postoperative treatment: instruct the patient to suspend in the forearm sling for 4 weeks after operation. Move elbow joint and wrist joint immediately after operation. Practice passive shoulder joint activity after 4 weeks. Practice active activities and strength exercise after 12 weeks.b. Conservative group:Patients were fixed with 8-shaped clavicle bandage for 8-12 weeks, and forearm sling was suspended for 8-12 weeks. Practice passive shoulder joint activity after 4 weeks. Practice active activities and strength exercise after 8 to 12 weeks. (2) Evaluation criteria:Every index of two groups of patients was recorded. after 1,3,6 and 12 months' follow-up, the patient's constant score and quick dash score were recorded to comprehensively evaluate the shoulder joint function. Visual analogue scale (vas) was used to evaluate the pain of patients. (3) StatisticalAnalysis:Using SPSS 24.0 software, the measurement data were expressed by ±s, the comparison between groups was made by t test, and the counting data were tested by χ² test, P<0.05 was considered statistically significant.

(1) Comparison of Constant scores:At 12th month, the Constant scores of both groups were significantly higher than those before operation or conservative treatment (P<0.05) , indicating that both treatment methods could make the patients achieve good recoveries. At the 3rd, 6th and 12th months, there was no statistical difference in the Constant scores between two groups. At the 1st month of follow up, the Constant score in the conservative group was significantly higher than that in the reconstruction group (P<0.05) . (2) Comparison of Quick DASH scores: At 12th month, the Quick DASH scores of both groups were significantly lower than those before operation or conservative treatment (P<0.05) , indicating that both treatment methods could make the patients achieve good recoveries. At the 6th and 12th months, there was no statistical difference in the Quick DASH scores between two groups. At the 1st and 3rd month of follow ups, the Quick DASH score in the conservative group was significantly lower than that in the reconstructive group (P<0.05) . (3) Comparison of VAS scores:. At 12th month, the VAS scores of both groups were significantly lower than those before operation or conservative treatment (P>0.05) , indicating that both treatment methods could make the patients pain free, and the VAS scores between the two groups were not statistically significant. At the 1st, 3rd and 6th months of follow ups, the VAS score in the conservative group was significantly lower than that in the reconstruction group (P<0.05) . (4) Comparison of complications: The complication rate was 19.05% in the conservative treatment group and 20% the reconstruction group at time of last follow up. There was no statistical difference in the complication rates between the two groups (P>0.05) . (5) Comparison of radiographic results. Both conservative treatment and AHPLT reconstruction of Rockwood type III acromioclavicular joint dislocation could achieve a good reduction effect.

For Rockwood type III acromioclavicular joint dislocation, AHPLT reconstruction or conservative treatment can both obtain satisfactory results. In the choice of treatment options, clinicians should proceed from the individual patients and follow their wishes to give them the most suitable individualized treatment.