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中华肩肘外科电子杂志 ›› 2024, Vol. 12 ›› Issue (01) : 78 -83. doi: 10.3877/cma.j.issn.2095-5790.2024.01.013

病例报告

关节镜下治疗肩锁关节脱位伴喙突基底部骨折的病例报告及文献回顾
刘沛东1, 梁求真1, 郑江1, 张亮1,()   
  1. 1. 710054 西安交通大学附属红会医院运动医学诊疗中心;710054 西安,陕西省运动与康复临床研究中心
  • 收稿日期:2023-06-07 出版日期:2024-02-05
  • 通信作者: 张亮
  • 基金资助:
    陕西省科技厅重点研发计划(2023-YBSF-141); 陕西省科技厅基础研究计划资助项目(2022JQ-865)
  • Received:2023-06-07 Published:2024-02-05
引用本文:

刘沛东, 梁求真, 郑江, 张亮. 关节镜下治疗肩锁关节脱位伴喙突基底部骨折的病例报告及文献回顾[J]. 中华肩肘外科电子杂志, 2024, 12(01): 78-83.

上肩胛悬吊复合体(superior shoulder suspensory complex,SSSC)是稳定肩关节的重要结构,其是由喙突、肩峰、肩锁韧带、喙锁韧带、喙肩韧带、肩锁关节、肩关节盂等组成的骨与软组织环[1]。悬吊复合体中有2个或以上部位的损伤会造成肩关节不稳定,导致飘浮肩。若不予以治疗恢复整个SSSC的完整性,会导致骨折畸形愈合、盂肱关节不稳定、创伤性关节炎及肩关节疼痛等并发症[2]

图1 患者男性,49岁,摔伤致右肩锁关节脱位、喙突骨折 图A:右肩关节X线片示:肩锁关节脱位,锁骨远端上移;喙突基底部骨折,连续性中断,移位明显;图B:右肩关节三维重建示:肩锁关节脱位Rockwood分型Ⅲ型,肩锁关节韧带破坏,喙锁韧带破坏,锁骨外端完全移位,喙突与锁骨之间的距离明显增大;图C:喙突基底部骨折Eryes分型V型:喙突延伸至关节盂处的关节内骨折
图2 肩关节镜下治疗肩锁关节脱位伴喙突基底部骨折的手术照片 图A:刨刀清理喙突基底部致关节盂处骨折;图B:复位后钻孔;图C:关节镜监视下空心螺钉固定;图D:锁骨远端骨面新鲜化;图E:于锁骨前后缘分别拧入2枚带线锚钉;图F:抓钳牵拉肩锁韧带及部分关节囊,测试覆盖情况;图G-H:过线器牵引过线,将肩锁韧带及部分关节囊打结固定,复位肩锁关节
图3 本例患者损伤模式及手术示意图 图A:损伤示意图:SSSC作为稳定肩关节的重要环形结构(绿色圆环),主要由喙突、肩锁关节、肩关节盂等组成,该患者骑车摔伤致右肩部受到向前向上的作用力,导致肩锁关节脱位并喙突基底部骨折;图B:手术示意图:于关节盂处置入空心螺钉固定喙突基底部骨折,再于锁骨远端前后缘分别置于2枚带线锚钉,弹性复位固定肩锁关节,恢复肩关节完整性及稳定性
图4 术后患者的影像学检查 图A:术后X线片显示肩锁关节复位满意,喙突处可见内固定影;图B-F:术后1个月复查肩关节CT及MRI,红色箭头所指即为术后1个月时空心螺钉及带线锚钉骨道置入影;图G-H:术后1年复查CT,绿色箭头所指为空心螺钉及带线锚钉骨道影,骨折已基本愈合,肩锁关节在位
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