改良钛缆系统结合肩锁韧带修复治疗肩锁关节脱位

doi:10.3877/cma.j.issn.2095-5790.2020.03.003

目的

研究改良钛缆系统结合肩锁韧带修复治疗肩锁关节脱位临床效果。

方法

对2014年1月至2019年3月期间在本院使用改良钛缆系统结合肩锁韧带修复进行治疗的21例肩锁关节脱位患者临床资料进行分析，包括脱位类型、受伤原因、手术时间、关节活动范围、X线片检查结果、美国肩肘协会评分（American shoulder and elbow surgeons，ASES）、Constant肩关节评分及Karlsson术后疗效评价。

结果

21例患者获得随访，随访时间（13.05 ±2.62）个月，手术时间（50.57±8.13）min，术前等待时间（2.71±1.35）d。肩关节活动范围：前屈（167.14±5.19）°，后伸（41.14±2.20）°，外展（167.24±7.07）°，外旋（52.10±4.99）°，内旋（83.33±3.61）°。ASES评分（94.19±4.01）分（86.67 ~ 100分），Constant评分（92.95±4.98）分（78 ~ 99分），根据Karlsson术后疗效评价标准：优为15例（71.4%）、良为6例（28.6%）。

结论

改良钛缆系统结合肩锁韧带修复技术治疗肩锁关节脱位可以获得良好的临床效果。

关键词: 肩锁关节脱位, 钛缆, 肩锁韧带

Background

Acromioclavicular joint dislocation is a common clinical shoulder injury, and it is more common in young patients. The treatment requirements are high. If improperly handled, it will cause shoulder pain and shoulder joint dysfunction. The current view is that for Rockwood type I and Ⅱ acromioclavicular joint dislocation, conservative treatment can achieve good results. For Rockwood type Ⅲ acromioclavicular joint dislocation, it depends on the specific situation, and Rockwood typeⅣ,Ⅴ, Ⅵ acromioclavicular joint dislocation should be treated surgically. However, there are various treatment methods for acromioclavicular joint surgery, and there is no unified understanding. At present, it is more inclined to anatomical reconstruction and minimally invasive surgery, including Tightrope technology, autologous/artificial tendon, and threaded anchors to reconstruct the coracoclavicular ligament, but there are disadvantages such as poor suture/tendon strength, subluxation of the acromioclavicular joint, and iatrogenic fracture.

Objective

To investigate the clinical effect of modified titanium cable system combined with acromioclavicular ligament repair for treatment of acromioclavicular joint dislocation.

Methods

From January 2014 to March 2019, 21 patients with acromioclavicular joint dislocation were treated with modified titanium cable system and acromioclavicular ligament repair in our hospital, and the clinical data, including dislocation type, injury causes, operation time, range of joint motion, X-ray findings, American shoulder and elbow association (ASES) score, Constant shoulder score, and Karlsson postoperative evaluation were retrospectively analyzed.

Results

All patients were followed up for (13.05±2.62) months.The operation time was (50.57±8.13) minutes, and the waiting time before surgery was (2.71±1.35) days. The ranges of shoulder motion were (167.14 ± 5.19) ° of forward flexion, (41.14 ± 2.20) °, abduction (167.24±7.07) ° of posterior extension, (52.10±4.99) ° external rotation, and (83.33 ± 3.61) ° internal rotation. The ASES score was (94.19±4.01) (86.67-100) points, and the Constant-Murley score was (92.95±4.98) (78-99) points. According to Karlsson's postoperative evaluation criteria, 15 cases (71.4%) were excellent and 6 cases (28.6%) were good.

Conclusions

Modified titanium cable system combined with acromioclavicular ligament repair technology can achieve good clinical results in the treatment of acromioclavicular joint dislocation.

Key words: Acromioclavicular joint dislocation, Titanium cable, Acromioclavicular ligament

图1 典型病例：患者男，47岁，骑自行车摔伤致左侧肩锁关节脱位（RockwoodⅤ型），术前左肩锁关节正位X线片示锁骨肩峰端完全脱位（图A），对侧肩锁关节关系良好（图B），手术取沙滩椅体位，触诊后勾勒肩锁关节和喙突位置（图C），手术取锁骨远端横形和喙突部位纵行切口（图D），用钛缆进行固定并修复肩锁韧带（图E-F），术中透视显示肩锁关节关系恢复（图G）,剪除多余的钛缆后透视及术后X线片（图I）

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Modified titanium cable system combined with acromioclavicular ligament repair for acromioclavicular joint dislocation

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Modified titanium cable system combined with acromioclavicular ligament repair for acromioclavicular joint dislocation