中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (17): 3212-3216.doi: 10.3969/j.issn.1673-8225.2011.17.041

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

金属缝合锚治疗肩锁关节脱位20例

杨  顺1，姜春岩2，向  明1，牟建雄1，陈  杭1，杨国勇1   

  1. 1四川省骨科医院上肢创伤科，四川省成都市610041
    2北京积水潭医院，北京市  100035
  • 收稿日期:2010-12-14 修回日期:2011-02-16 出版日期:2011-04-23 发布日期:2011-04-23
  • 通讯作者: 姜春岩，博士，主任医师，副教授，北京积水潭医院运动医学科，北京市 100035 chunyanj@hotmail.com
  • 作者简介:杨顺，男，1972年生，山东省泗水县人，汉族，1994年长春中医药大学毕业，主治医师，主要从事上肢创伤(肩肘外科重建、手外科)研究。 yangs_666@sina.com

Application of suture anchor to treat acromioclavicular dislocation in 20 cases

Yang Shun1, Jiang Chun-yan2, Xiang Ming1, Mou Jian-xiong1, Chen Hang1, Yang Guo-yong1   

  1. 1Department of Upper Extremity Trauma, Orthopedic Hospital of Sichuan Province, Chengdu  610041, Sichuan Province, China
    2Beijing Jishuitan Hospital, Beijing  100035, China
  • Received:2010-12-14 Revised:2011-02-16 Online:2011-04-23 Published:2011-04-23
  • Contact: Jiang Chun-yan, Doctor, Chief physician, Associate professor, Beijing Jishuitan Hospital, Beijing 100035, China chunyanj@hotmail.com
  • About author:Yang Shun, Attending physician, Department of Upper Extremity Trauma, Orthopedic Hospital of Sichuan Province, Chengdu 610041, Sichuan Province, China yangs_666@sina.com

PDF

501

被引次数

4

摘要：

背景：肩锁关节脱位由于固定难度大，后期并发症高，临床治疗较为棘手。对于严重肩锁关节脱位的治疗，存在诸多争议。
目的：介绍应用锁骨远端切除缝合锚重建喙锁韧带治疗肩锁关节脱位的方法，以及临床病例随访疗效分析。
方法：对四川省骨科医院2006-11/2009-01收治的20例肩锁关节脱位患者进行随访，均行锁骨远端切除，缝合锚临时重建喙锁功能，联合腱外1/2转位重建喙锁韧带，可避免肩锁关节炎的发生。最终随访时应用放射学评估，并采用UCLA评分、Constant评分以及肩关节简明测试问卷SST进行肩关节功能评估。
结果与结论：重建后随访9~26个月，所有患者术中锁骨远端高度均达到解剖复位。终末随访时，平均UCLA评分为33分，平均Constant评分为91.6分，平均前屈上举146.4°，平均外旋45.6°，肩关节简明测试问卷SST的肯定答案平均为 12个，总体优良率为85%(17/20)。缝合锚组织相容性好，生物适应性佳，固定坚固可靠，可确保充分的初期固定；锁骨远端切除预防了肩锁关节炎的发生；联合腱外侧半作为移植物的来源有足够的长度，同时也避免牺牲喙肩韧带，从而保存了完整的喙肩弓。提示应用锁骨远端切除缝合锚重建喙锁韧带治疗肩锁关节脱位，可恢复喙锁韧带维持喙锁间隙的功能，手术时间短，重建后并发症少，无需二次手术，配合重建后功能锻炼，肩关节功能能够恢复至原有水平。

关键词: 肩锁关节脱位, 缝合锚, 锁骨远端切除, 喙锁韧带, 功能恢复

Abstract:

BACKGROUND: Fixation of acromioclavicular dislocation is difficult and often accompanied with complications in late stage in clinic. There are many disputes about treatment of severe acromioclavicular dislocation.
OBJECTIVE: To introduce the procedure of distal clavicle excision and reconstruction of coracoclavicular ligament with suture anchor to treat acromioclavicular dislocation and to analyze the effect on clinical cases.
METHODS: Twenty cases were followed up from November, 2006 to January, 2009, diagnosed as acromioclavicular dislocation. Radiological evaluation was applied at final follow up. In addition, shoulder function was measured according to UCLA, Constant Scores and Shoulder Concise Questionnaire (SST).
RESULTS: A mean time of 15.6 months (9-26 months) follow-up was completed after surgery. The height of distal clavicle in all patients reached anatomical reduction. The average UCLA score was 33 (28-35), and the average Constant score was 91.6 (82-96).The average forward flexion and elevation was 146.4°, and that of external rotation was 45.6°. Positive answers in SST questionnaire were 12 at average. The rate of excellence and good was 85% (17/20) in common. Positive answers were gained, when the same operative treatment was readily accepted if the same fracture arose at contralateral shoulder. Distal clavicle excision and coracoclavicular ligament reconstruction with suture anchor is an effective method to treat acromioclavicular dislocation resulted from severe trauma. Suture anchor has the advantages of good compatibility and adaptation, reliable fixation with high strength in order to obtain stable early fixation. Distal clavicle excision prevents acromioclavicular arthritis. As a choice of allograft, the lateral half of the conjoined tendon not only have enough length, but also prevent the sacrifice of the coracoacromial ligament, so that the complete coracoacromial arch is reserved. For the patient who has co-exiting rotator cuff injury, the lateral half of the conjoined tendon is a good choice of allograft. Reconstruction of coracoclavical ligament with suture anchor, repair of the coracoclavical ligament and restore the function of the coracoclavical space have the advantages of short operation time, less complication and no need of secondary operation. In combination with postoperative rehabilitative exercises, the function of shoulder can reach original sport level.

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