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中华肩肘外科电子杂志 ›› 2022, Vol. 10 ›› Issue (01) : 28 -33. doi: 10.3877/cma.j.issn.2095-5790.2022.01.006

论著

关节镜下喙锁和肩锁韧带重建治疗陈旧性Rockwood III型肩锁关节脱位
张亚军1, 党育2, 杨剑3, 张刘会3, 谭利3, 杨忠3, 郁凯3,()   
  1. 1. 100044 北京大学人民医院创伤救治中心
    2. 100044 北京大学人民医院创伤骨科
    3. 300450 天津市第五中心医院骨科
  • 收稿日期:2021-11-20 出版日期:2022-02-05
  • 通信作者: 郁凯
  • 基金资助:
    国家重点研发计划(2018YFF0301103)

Arthroscopic reconstruction of acromioclavicular and coracoclavicular ligaments in the treatment of chronic Rockwood type III acromioclavicular joint dislocation

Yajun Zhang1, Yu Dang2, Jian Yang3, Liuhui Zhang3, Li Tan3, Zhong Yang3, Kai Yu3,()   

  1. 1. Trauma Medicine Center, People’s Hospital, Peking University, Beijing 100044, China
    2. Department of Orthopedics and Trauma, People’s Hospital, Peking University, Beijing 100044, China
    3. Department of Orthopedics, Tianjin Fifth Central Hospital, Tianjin 300450, China
  • Received:2021-11-20 Published:2022-02-05
  • Corresponding author: Kai Yu
引用本文:

张亚军, 党育, 杨剑, 张刘会, 谭利, 杨忠, 郁凯. 关节镜下喙锁和肩锁韧带重建治疗陈旧性Rockwood III型肩锁关节脱位[J]. 中华肩肘外科电子杂志, 2022, 10(01): 28-33.

Yajun Zhang, Yu Dang, Jian Yang, Liuhui Zhang, Li Tan, Zhong Yang, Kai Yu. Arthroscopic reconstruction of acromioclavicular and coracoclavicular ligaments in the treatment of chronic Rockwood type III acromioclavicular joint dislocation[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2022, 10(01): 28-33.

目的

探讨关节镜下喙锁+肩锁韧带重建治疗陈旧性Rockwood III型肩锁关节脱位的疗效。

方法

选取2016年1月至2020年12月北京大学人民医院收治的14例确诊为陈旧性肩锁关节脱位患者,其中男8例、女6例,平均年龄(37.2±10.1)岁,平均受伤时间(13.4±3.5)个月,累及优势侧肩关节7例,均行关节镜下喙锁+肩锁韧带重建手术。术后所有患者分别于不同时间点随访(术后1、3、6、12个月),进行视觉模拟评分(visual analogue scale,VAS)和美国加州大学洛杉矶分校(University of California, Los Angeles,UCLA)评分。

结果

14例确诊为陈旧性肩锁关节脱位患者(均为Rockwood III型)进入研究并完成手术,12例获得完全随访,平均随访(26.3±8.6)个月(12~36个月)。患者术前和术后1个月、3个月、6个月、12个月VAS评分分别为(5.667±0.414)分、(5.583±0.288)分、(4.583±0.229)分、(2.833±0.271)分、(0.538±0.193)分,与术前相比,所有患者在术后3个月、6个月和12个月随访时均显示疼痛减轻,术后6个月和12个月疼痛减轻的程度与术前相比(VAS评分变化)差异有统计学意义(P<0.001)。患者术前和术后1个月、3个月、6个月、12个月UCLA评分分别为(19.083±0.468)分、(18.583±0.434)分、(21.000±0.628)分、(25.750±0.579)分、(32.750±0.509)分,与术前相比,所有患者在术后3个月、6个月和12个月随访时UCLA评分与术前相比均有提高,术后6个月、12个月随访时UCLA评分改善的程度与术前相比,差异有统计学意义(P<0.001)。

结论

关节镜下喙锁+肩锁韧带重建可以用较小的创伤达到帮助陈旧性肩锁关节脱位患者减轻疼痛和改善肩关节功能的目的。

Background

Acromioclavicular joint dislocation is common in the clinic, mostly in young adults and people who like sports. Patients with less severe injuries, such as Rockwood I, II, and some III, can be treated with conservative therapy with satisfactory results. In contrast, Rockwood types IV, V, and VI with severe acromioclavicular dislocation require surgery. The most controversial treatment is Rockwood type III, where persistent dislocation of the acromioclavicular joint leads to persistent pain and dysfunction due to failure of conservative treatment. However, due to the obsolescence stage at the time of treatment, different clinical reports have a certain incidence of poor reduction, loss of reduction, and residual pain. We proposed the method of coracoclavicular ligament + acromioclavicular ligament reconstruction under arthroscopy, which gives full play to the advantages of minimally invasive surgery and has certain significance for improving postoperative shoulder joint function and alleviating pain.

Objective

To investigate the effect of arthroscopic reconstruction of coracoclavicular and acromioclavicular ligaments in treating chronic Rockwood type III acromioclavicular joint dislocation.

Methods

A total of 14 patients diagnosed with old acromioclavicular dislocation from January 2016 to December 2020 were selected, including 8 males and 6 females, with an average age of (37.2±10.1) years and an average injury time of (13.4±3.5) months, and 7 patients with dominant shoulder joint involved. All underwent arthroscopic coracoclavicular + acromioclavicular ligament reconstruction. Each patient was followed up at different postoperative time points (1, 3, 6, 12 months after surgery) , and pain (VAS score) and shoulder function (UCLA score) were evaluated.

Results

Fourteen patients diagnosed with obsolete acromioclavicular dislocation (all Rockwood type III) entered the study. They completed surgery, and 12 were thoroughly followed up, with a mean follow-up of (26.3±8.6) months (12-36 months) . (1) VAS score: Preoperative, postoperative 1 month, 3 months, 6 months and 12 months scores were (5.667±0.414) point, (5.583±0.288) point, (4.583±0.229) point, (2.833±0.271) point, (0.538±0.193) point, respectively. Compared with pre-operation, all patients showed pain relief at 3, 6 and 12 months after surgery, and the degree of pain relief (changes in VAS score) at 6 and 12 months after surgery was statistically improved (P<0.001) . (2) UCLA score: Preoperative, postoperative 1 month, 3 months, 6 months and 12 months scores were (19.083±0.468) point, (18.583±0.434) point, (21.000±0.628) point, (25.750±0.579) point, (32.750±0.509) point, respectively. Compared with pre-operation, UCLA scores of all patients at the 3rd, 6th and 12th months follow-up was improved, and the UCLA scores improvement at 6- and 12-months follow-up was statistically different (P<0.001) .

Conclusion

Arthroscopic reconstruction of coracoclavicular and acromioclavicular ligaments can relieve pain and improve shoulder function in patients with chronic acromioclavicular dislocation with less trauma.

图1 微型钛板喙锁固定+肩锁关节重建术示意图(右肩正面观)
图2 微型钛板喙锁固定+肩锁关节重建术示意图(右肩俯视图),重建肩锁关节的同时,可吸收缝线缝合受损的肩锁韧带及关节囊
图3 患者术前肩关节正位X线片提示肩锁关节脱位Rockwood III型
图4 患者术前肩关节CT提示肩锁关节脱位Rockwood III型
图5 术中重建肩锁韧带
图6 术中透视肩锁关节复位情况
图7 术后不同随访时间VAS评分变化注:VAS为视觉模拟评分;与术前相比,aP<0.05
图8 术后不同随访时间UCLA评分变化注:UCLA为美国加州大学洛杉矶分校;与术前相比,aP<0.05
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