肩锁关节损伤影像研究

目的 探讨正常肩锁关节和肩锁关节脱位的影像表现. 方法 选取正常肩关节CR片68例、正常胸部正位CR片400例,测量肩锁关节间距距离和肩锁关节下皮质线关系.正常肩关节MRI 30例,临床证实肩锁关节脱位24例,肩撞击综合征7例,观察X线、MRI表现.结果 正常人肩锁关节间距为(3.36±0.44) mm;肩锁下皮质为一连续弧线.肩锁关节脱位24例中,按Rockwood分类,Ⅰ级7例,Ⅱ级5例,Ⅲ级12例;Ⅱ、Ⅲ级者肩锁关节间距增宽＞4.3 mm;Ⅲ级者肩锁关节下皮质弧线不连续.MRI发现Ⅱ级者关节软骨盘碎裂,关节囊和肩锁韧带撕裂,Ⅲ级者合并喙锁韧带撕裂.结论肩锁关节间距和下皮质弧线对诊断肩锁关节脱位分级有重要作用,MRI是确诊的有效方法.     

MRI在肩锁关节损伤中的临床应用价值

目的:探讨肩锁关节(ACJ)损伤的MRI影像表现和诊断价值。方法:收集自2008年6月～2009年12月间共38例经手术及临床治疗证实的肩锁关节外伤患者的MRI检查,对ACJ损伤的核磁共振表现进行观察分析并按Tossy分类进行分级。结果:38例ACJ损伤中Ⅰ级损伤7例,表现为肩锁韧带部分撕裂。Ⅱ级损伤9例,表现为肩锁韧带完全撕裂,伴有喙锁韧带的扭伤或部分撕裂。Ⅲ级损伤19例,表现为肩锁韧带和喙锁韧带完全撕裂。慢性损伤3例,表现为肩锁韧带或喙锁韧带增厚和信号减低。ACJ损伤的伴随征象主要有关节囊积液、关节盘撕裂和骨挫伤等。结论:MRI对ACJ损伤的显示率高,并能进行准确分级,具有较高的临床应用价值。     

肩锁关节韧带损伤的磁共振成像评价

目的：探讨肩锁关节韧带（ACJL）损伤的磁共振成像（MRI）影像表现和诊断价值。方法收集自2009年4月至2013年8月间共52例经手术及临床治疗证实的肩锁关节韧带损伤患者的MRI检查,对ACJ韧带损伤的核磁共振表现进行观察分析并按Tossy标准进行分级。结果52例ACJL损伤中Ⅰ级损伤19例,表现为肩锁韧带部分撕裂。Ⅱ级损伤19例,表现为肩锁韧带完全撕裂,伴有喙锁韧带的扭伤或部分撕裂。Ⅰ至Ⅱ级5例。Ⅲ级损伤9例,表现为肩锁韧带和喙锁韧带完全撕裂。ACJL损伤的间接征象主要有肩锁关节间隙增宽、关节囊积液、邻近骨折及骨与周围软组织挫伤等。结论 MRI对ACJL损伤的显示率高,并能进行准确分级,具有较高的临床应用价值。     

张力带内固定手术治疗肩锁关节脱位36例临床分析

肩锁关节脱位为骨科常见病、多发病,治疗手段多样化,根据TOSSI分型,将肩锁关节脱位分为三型,Ⅰ型损伤:肩锁关节处少许关节囊及韧带撕裂,关节结构稳定,疼痛轻微,X线片显示正常。Ⅱ型损伤:肩锁关节处关节囊及韧带撕裂,常有半脱位,但喙锁韧带无损伤,肩关节处有疼痛,X线片显示锁骨高于肩峰,但小于锁骨高度。Ⅲ型损伤:肩锁关节处     

锁骨钩钢板治疗锁骨远端骨折及肩锁关节脱位

肩锁关节脱位和锁骨远端骨折是一种常见的损伤。常用的治疗方法有克氏针钢丝张力带、锁骨喙突螺丝钉固定及动力性Devar手术等,这些方法能取得一定的固定及复位效果,但严重的锁骨远端NeerⅡ型骨折和肩锁关节TossyⅢ型脱位,常伴有喙锁韧带断裂,造成锁骨远端向上向后移位,疗效     

重建肩锁韧带及喙锁韧带治疗陈旧性肩锁关节脱位

目的探讨治疗陈旧性肩锁关节脱位的新方法：方法采用喙肩韧带加强重建肩锁韧带、喙突部肱二头肌短头与喙肱肌联合腱肌筋膜加强重建喙锁韧带治疗陈旧性肩锁关节脱位29例，获得随访25例，按A11man等分型：Ⅱ度10例，Ⅲ度15例。随访观察3～36个月。结果依照Lazzcano评定标准，优16例、良9例，无其他并发症，肩锁关节无再脱位。结论喙肩韧带加强重建肩锁韧带、喙突部肱二头肌短头与喙肱肌联合腱肌筋膜加强重建喙锁韧带治疗陈旧性肩锁关节脱位既有良好固定脱位的作用，又符合肩锁关节的微动生理，是一种较为理想的治疗方法：     

交叉克氏针及丝线固定肩锁关节脱位25例

自1995年以来,我们采用交叉克氏针及丝线8字贯穿缝合法治疗肩锁关节脱位25例,取得良好效果。1　临床资料1.1　一般情况　本组男18例,女7例;年龄21～50岁,平均36岁。受伤原因为摔伤、砸伤或撞伤,均为直接暴力。按Post分类:级(即肩锁关节半脱位伴肩锁及喙锁韧带不全断裂)6例,级(即肩锁关节全脱位伴肩锁及喙锁韧带完全断裂)19例。伤后至手术时间:2d～3个月,平均6d。1.2　手术方法　采用颈丛麻醉。自肩峰经锁骨外端向前内侧至喙突做一弧形切口,长10～12cm,充分显露肩锁关节并清除关节内积血及瘢痕组织,使脱位的锁骨外端复位。从肩峰外侧向锁骨…     

锁骨钩钢板治疗肩锁关节脱位

肩锁关节脱位多由外力自肩上部向下冲击肩峰或跌倒时肩部着地引起,肩锁关节脱位临床较为常见,可分为Ⅰ～Ⅲ度.Ⅲ度肩锁关节损伤是肩锁韧带、喙锁韧带、关节囊完全断裂.保守治疗无效,主张早期行手术治疗.本科自2000年1月-2004年1月采用锁骨钢板治疗Ⅲ度肩锁关节脱位42例,疗效满意.报告如下.     

喙突上移治疗肩锁关节脱位11例

我院自1988年始用喙突上移治疗肩锁关节脱位11例，效果确实，现报告如下。临床资料1．一般情况：本组男8例，女3例，年龄18～45岁，平均31岁。交通事故3例，钝性击伤4例，高处跌伤2例，原因不明2例。按Zlotsky等[1]分级，11例均为3级，均是肩锁韧带和喙锁韧带撕裂，引起肩锁关节脱位。合并伤：颅脑外伤4例，同侧肢体骨折3例，腹内脏器伤1例。就诊时间：伤后0．5h~4d，平均12h。2手术方法：手术均在高位肌间沟麻醉下进行。仰卧，肩后垫枕，头转向健侧。于锁骨上的一横指处行横弧形切口，自锁骨中点至肩锁关节，显露喙突及肩锁关节，修整、清…     

关节镜下喙突无骨道悬吊技术治疗Rockwood Ⅲ型急性肩锁关节脱位疗效分析

<正>肩锁关节脱位临床上表现为肩锁关节失稳、疼痛、活动受限,锁骨远端凸起,多可触及浮动感。该类损伤的Rockwood分型目前在临床应用较为广泛,具有良好的临床指导意义[1],其中Ⅲ型以上的损伤类型提示肩锁及喙锁稳定性同时丢失。喙锁韧带的撕裂在垂直向导致的应力丢失对关节不稳产生主要影响,恢复其垂直向的力学牵拉是治疗肩锁关节向上方脱位的重要平衡力偶[2]。肩锁关节为微动关节,传统刚性固定暴露出越来越多的问题,软固定的治疗理念由此应运而生,     

双带袢钢板技术治疗NeerⅡ型锁骨远端骨折的疗效分析

目的探讨双带袢钢板技术治疗NeerⅡ型锁骨远端骨折的效果。方法回顾性分析2010年5月—2014年5月核工业二一五医院骨一科治疗的21例NeerⅡ型锁骨远端骨折患者资料,男性15例,女性6例;年龄21~58岁,平均37.0岁。骨折分型均为NeerⅡ型锁骨远端骨折,并且喙锁韧带断裂。以喙锁韧带在锁骨止点为中心,沿锁骨走行做切口,直视下用直径为2.0mm克氏针作为导针钻孔贯穿锁骨、喙突,空心钻(直径为4.5mm)顺导针经过锁骨和喙突钻孔,制造出相连的2个骨孔道,测量2个骨孔道连同2个骨孔道之间总长度。将2块带袢钢板环环扣套,用骨科2#线穿引作为引导线,经喙突骨孔道、锁骨骨孔道依次穿过,两边带袢钢板分别悬吊于锁骨上表面与喙突下表面,沿斜方韧带走形用喙突端的引导线穿过锁骨远端的另一个孔道打结绑扎。术后1、6个月,按照Constant-Muley肩关节功能评分系统评定疗效。结果术后随访时间6~30个月(平均12.0个月)。术后随访X线片示骨折复位良好。骨折愈合时间为5~12周,平均6.5周。术后2个月复查所有患者均恢复肩部活动。术后1个月Constant-Muley评分:优1例,良13例,差7例,平均为83.5分(64~91分);术后6个月,优19例,良2例,平均为93.0分(89~98分)。末次随访时未出现肩部疼痛、感染及骨折错位、延迟愈合等并发症。结论采用双带袢钢板技术治疗NeerⅡ型锁骨远端骨折效果良好,值得推广。     

改良Weaver法治疗肩锁关节脱位

完全性肩琐关节脱位常伴有喙锁韧带断裂，我院自１９９１－１９９６年５年间对１８例Ⅲ度肩锁关节新鲜脱位伴喙锁韧带断裂者行切开复位克氏针内固定和喙肩韧带移行代替喙锁韧带（改良Ｗｅａｖｅｒ）手术，取得满意疗效。术后随访平均２４个月，无脱位或半脱位发生，依Ｌａｚｚｃａｎｏ标准评定：优１７例，良１例。     

双RigidLoop悬吊钛板重建喙锁韧带联合肩锁韧带修复治疗急性肩锁关节脱位的早期疗效观察

目的 比较双RigidLoop悬吊钛板重建喙锁韧带联合肩锁韧带修复与钩钢板治疗RockwoodⅢ型急性肩锁关节脱位的早期临床疗效.方法 回顾性分析2016年3月—2019年5月西安交通大学第二附属医院骨一科收治的RockwoodⅢ型急性肩锁关节脱位患者58例,男性41例,女性17例;年龄20～65岁,平均38.9岁.根...     

喙锁韧带重建与锁骨钩钢板治疗RockwoodⅢ型肩锁关节脱位手术效果比较

目的对比研究喙锁韧带重建与锁骨钩钢板治疗RockwoodⅢ型肩锁关节脱位手术效果。方法回顾性分析2013年3月~2015年2月收治的36例RockwoodⅢ型创伤性肩锁关节脱位患者的临床资料,其中男性27例,女性9例;年龄19~32岁,平均24.7岁。18例行喙锁韧带带袢钢板(Endobutton)重建手术治疗(A组),18例行锁骨钩钢板手术治疗(B组)。对两组患者手术时间、术后疼痛视觉模拟评分(visual analogue scale,VAS)及Constant-Murley肩关节功能评分方面进行比较分析。结果两组患者平均手术时间分别为(59±4)min(A组)、(54±6)min(B组),两组间差异没有统计学意义(P=0.596);术后VAS分别为(1.8±0.7)分(A组)、(1.5±1.1)分(B组),差异无统计学意义(P=0.612);术后12周患者ConstantMurley肩关节功能评分分别为(91±3.7)分(A组)、(83±6.2)分(B组),B组患者的肩关节功能评分较A组低,两组间评分差异有统计学意义(P=0.027)。结论采取Endobutton悬吊重建喙锁韧带功能,固定肩锁关节脱位,更好地恢复了肩锁关节作为微动关节的生物力学及运动轨迹,未增加手术时间及导致创伤,肩关节功能恢复良好,较锁骨钩钢板是一种更理想的手术方式。     

Simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft

Purpose

The purpose of this study was to introduce a novel surgical technique for simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft and to compare its biomechanical characteristics to those of a coracoid cerclage reconstruction of the coracoclavicular ligaments.

Methods

Six matched pairs of human acromioclavicular joints with an average age of 54.8 ± 7.8 years were used. One shoulder from each pair received the single tendon acromioclavicular–coracoclavicular reconstruction; the contralateral shoulder received the coracoid cerclage reconstruction. Bovine extensor tendon was used for both techniques. The single tendon acromioclavicular–coracoclavicular reconstruction technique provided anatomic restoration of the two coracoclavicular ligaments and the superior and inferior acromioclavicular ligaments simultaneously using one coracoid hole, one acromion hole, and two clavicular holes with interference screws. Anterior–posterior and superior–inferior translations were quantified for all specimens before and after reconstruction, followed by load to failure testing.

Results

Following coracoid cerclage reconstruction, total anterior–posterior translation was significantly greater than intact (10.0 ± 5.7 mm; p = 0.008). Following single tendon acromioclavicular–coracoclavicular reconstruction, there was no significant difference in anterior–posterior translation compared to intact (?1.6 ± 2.2 mm; n.s.). The coracoid cerclage technique demonstrated significantly greater anterior–posterior translation than the single tendon acromioclavicular–coracoclavicular technique (p = 0.007). Both techniques restored superior–inferior translation to the intact condition (n.s.). Ultimate load, deformation at ultimate load, and energy absorbed at ultimate load were significantly greater after acromioclavicular–coracoclavicular reconstruction than after coracoid cerclage reconstruction (p < 0.05).

Conclusions

This novel single tendon anatomic acromioclavicular–coracoclavicular reconstruction provided greater stability and stronger load to failure characteristics than the isolated coracoid cerclage reconstruction. A simultaneous acromioclavicular–coracoclavicular reconstruction technique using a single free tendon graft provided anatomic reconstruction of the conoid, trapezoid, and superior and inferior acromioclavicular ligaments and may reduce postoperative subluxation.     

Stabilization of the clavicle after distal resection: a biomechanical study

BACKGROUND: The potential destabilizing effect of distal clavicle resection has received limited attention. HYPOTHESIS: Suturing the coracoacromial ligament to the undersurface of the distal clavicle after resection could counter clavicle instability. STUDY DESIGN: Controlled laboratory study. METHODS: The effect of ligament augmentation on posterior translation of the clavicle after resection was evaluated using 12 fresh-frozen cadaveric shoulders. Posterior clavicular displacement was measured after the application of a 70-N load under 4 different conditions: (1) the intact joint, (2) after distal clavicle resection, (3) clavicle resection plus acromioclavicular capsular ligament repair, and (4) clavicle resection plus acromioclavicular capsular ligament repair plus coracoacromial ligament augmentation. RESULTS: Mean displacements for each of the test conditions were as follows: (1) 5.60 mm, (2) 7.38 mm, (3) 7.54 mm, and (4) 6.34 mm. A 32% increase in posterior translation was measured after resection compared to the intact specimen. No reduction in posterior displacement was noted after capsular repair; however, displacement decreased significantly when capsular repair was coupled with ligament augmentation. CONCLUSIONS: Results suggest that the destabilizing effect of clavicle resection can be partially countered by the proposed ligament augmentation. CLINICAL RELEVANCE: That the destabilizing effect of clavicle resection can be partially countered by the proposed ligament augmentation may be particularly relevant in cases of resection for posttraumatic arthritis after acromioclavicular separation in which some degree of preexisting acromioclavicular capsular attenuation and consequently acromioclavicular joint laxity may be presumed.     

Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations

BACKGROUND: Surgical treatments of complete acromioclavicular joint dislocations replace or reconstruct the coracoclavicular ligaments with a single structure and do not account for the anatomical variance of each ligament in the design. PURPOSE: To evaluate the cyclic behavior and structural properties of an anatomic tendon reconstruction of the coracoclavicular ligament complex after a simulated acromioclavicular joint dislocation. STUDY DESIGN: Controlled laboratory study. METHODS: Cyclic loading followed by a load-to-failure protocol (simulated dislocation) of the normal coracoclavicular ligament complex was performed and repeated after an anatomic reconstruction on the same specimen (n = 9). The anatomical reconstruction consisted of a semitendinosus tendon that replicated the direction and orientation of both the trapezoid and conoid ligaments. RESULTS: The coracoclavicular ligament and anatomical reconstruction complexes had clinically insignificant (<3 mm) permanent elongation after cyclic loading. The stiffness and ultimate load of the coracoclavicular ligament complex (60.8 +/- 12.2 N/mm and 560 +/- 206 N) were significantly greater than for the anatomical reconstruction complex (23.4 +/- 5.2 N/mm and 406 +/- 60 N), respectively (P < .05). Further analysis of the complexes revealed a 40% decrease in the bending stiffness of the clavicle after the simulated dislocation and failure of the normal coracoclavicular ligament complex (P < .05), which contributed to the diminished properties of the anatomic reconstruction. CONCLUSIONS: The low level of permanent elongation after cyclic loading suggests that the anatomic reconstruction complex could withstand early rehabilitation; however, the decrease in the structural properties and stiffness of the clavicle should be considered in optimizing the anatomic reconstruction technique. CLINICAL RELEVANCE: Despite the differences compared to the normal coracoclavicular ligament complex, the anatomical reconstruction complex more closely approximates the stiffness of the coracoclavicular ligament complex than current surgical constructs, and the incorporation of biological tissue could improve the overall structural properties with healing.     

双带襻纽扣钢板技术治疗Neer Ⅱ型锁骨远端骨折和Tossy Ⅲ型肩锁关节脱位

目的评估应用双带襻纽扣钢板(Endobutton)技术治疗NeerⅡ型锁骨远端骨折和TossyⅢ型肩锁关节脱位的疗效。方法回顾性分析2009年4月~12月期间采用双Endobutton技术治疗NeerⅡ型锁骨远端骨折和TossyⅢ型肩锁关节脱位16例临床诊治资料,其中TossyⅢ型肩锁关节完全脱位10例,NeerⅡ型锁骨远端骨折6例,应用Constant评分系统进行评估。结果术后随访4~12个月,平均9个月。结果最近一次随访平均Constant评分得分91.8,12例日常活动、工作和运动正常,患侧肩关节无不适症状;4例体力劳动和运动时轻度疼痛。无再脱位及其他并发症。结论双Endobutton技术治疗锁骨远端骨折和肩锁关节脱位近期疗效满意,但远期疗效有待长期随访。