Surgical Treatment of Acromioclavicular Dislocation

The results of surgical treatment of 17 patients with complete acromioclavicular dislocation are presented. The operative procedure described is technically easy, gives good results, has few complications, and is not associated with the complications which often follow operations using metallic fixation devices. a second operation to remove fixation devices is avoided.     

Book review

Seventeen out of eighteen patients, who underwent the modified Bristow operation for anterior recurrent dislocation of the shoulder, were followed up after a mean observation time of 52 months. Fourteen patients were satisfied with the result. There were no redislocations. The principal limitation in range of motion was loss of some external rotation. Eight patients had non-union between the bone transplant and the glenoid rim, and four of these had complications related to the screw. Two had loosenings and two had fractures of the screw. Non-union without screw complications appeared not to influence the end result. The reasons for the complications seem to be technical problems concerning fixation and bone union of the coracoid process.     

双Endobutton技术治疗Ⅲ型肩锁关节脱位的临床观察

目的回顾分析应用双Endobutton技术治疗TossyⅢ型肩锁关节脱位的初步临床疗效。方法对12例TossyⅢ型肩锁关节脱位患者采用双Endobutton技术重建喙锁韧带治疗,全部病例获得8～14个月随访,平均12个月。结果按Lazzcano疗效评价标准进行评价,优10例,良2例,无再脱位及其他并发症。结论应用双Endobutton技术治疗TossyⅢ型肩锁关节脱位近期疗效满意,远期疗效有待长期随访。     

Subcoracoid dislocation of the distal clavicle: A case report with eight-year follow-up

Subcoracoid dislocation of the distal clavicle is an exceedingly rare injury that is typically the result of high-energy trauma, is often associated with concurrent injuries, and can easily be missed in the acute setting. Early open reduction with fixation of the acomioclavicular joint in these cases is recommended to optimise shoulder function and to avoid recurrent acomioclavicular instability and degenerative change. We present the unusual case of subcoracoid dislocation of the distal clavicle that did not require internal fixation or reconstruction following reduction, with satisfactory shoulder function maintained eight years after injury.     

带线锚钉修复喙锁韧带对肩锁关节脱位术后疼痛的影响

目的 探讨带线锚钉修复喙锁韧带对肩锁关节脱位患者术后肩关节疼痛的影响.方法 回顾性分析2017年2月～2020年6月本科开展手术治疗的45例RockwoodⅢ-V型肩锁关节脱位患者临床资料,依据术中是否接受喙锁韧带修复,分为两组:喙锁韧带修复组(观察组)22例,单纯钩钢板组(对照组)23例.记录两组患者的手术时间、术中...     

Acromioclavicular joint acceleration-deceleration injury as a cause of persistent shoulder pain: Outcome after arthroscopic resection

Background:

Shoulder pain in general and acromioclavicular joint (ACJ) pain specifically is common after acceleration-deceleration injury following road traffic accident (RTA). The outcome of surgical treatment in this condition is not described in the literature. The aim of the present study was to report the outcome of arthroscopic resection of the ACJ in these cases

Materials and Methods:

Nine patients with localized ACJ pain, resistant to nonoperative treatment were referred on an average 18 months after the injury. There were 3 male and 6 females. The right shoulder was involved in seven patients and the left in two. The average age was 38.9 years (range 29-46 years). All presented with normal X-rays but with torn acromioclavicular joint disc and effusion on magnetic resonance imaging (MRI). Arthroscopic ACJ excision arthroplasty was performed in all patients.

Results:

At a mean followup of 18 month, all patients had marked improvement. The Constant score improved from 36 to 81, the pain score from 3/15 to 10/15 and the patient satisfaction improved from 3.5/10 to 9.3/10.

Conclusion:

Arthroscopic ACJ excision arthroplasty, gives good outcomes in patients not responding to conservative management in ACJ acceleration-deceleration injury.     

悬挂式钢丝固定治疗肩锁关节脱位

目的探讨悬挂式钢丝固定治疗肩锁关节脱位的疗效。方法采用悬挂式钢丝固定治疗肩锁关节脱位患者24例。结果17例获随访,时间6个月~4年,肩锁关节功能恢复良好。结论用悬挂式钢丝固定治疗肩锁关节脱位,容易达到解剖复位和牢固的固定,是治疗肩锁关节脱位的一种方法。     

带袢钢板治疗肩锁关节完全性脱位的疗效及其影响因素

目的探讨带袢钢板技术在治疗完全性肩锁关节脱位的疗效及其影响疗效的因素。方法对26例肩锁关节脱位患者采用带袢钢板技术进行手术治疗。摄X线片测量袢钢板距离锁骨远端的相对距离[锁骨袢钢板中点到锁骨远端长度（L1）/锁骨长度（L）]术后6个月复位的丢失量。采用Constant肩关节评分法进行功能评估。结果 26例均获良好的复位。术后3 d喙锁距离为（28.41±4.14）mm,6个月时为（29.71±4.18）mm,平均丢失（1.30±1.18）mm。锁骨的袢钢板固定点和锁骨外缘的相对距离为0.21±0.03。Constant肩关节评分：术前为（30.65±6.18）分,术后为（91.03±5.21）分（t=-38.12,P〈0.001）。结论带袢钢板技术是一种非刚性固定肩锁关节的方式,闭合袢材料的生物力学足以维持肩锁关节的复位,术后疗效满意。骨道的定位、合适长度的袢钢板选择和术后正确的康复是减少术后复位丢失的重要因素。     

锁骨钩钢板治疗新鲜Tossy Ⅲ型肩锁关节脱位

2008年6月～2011年5月,我科采用锁骨钩钢板治疗13例新鲜Tossy Ⅲ型肩锁关节脱位患者,取得满意疗效.1 材料与方法1.1 病例资料本组13例,男10例,女3例,年龄18～45岁.左侧8例,右侧5例.患者均无合并神经损伤.均经X线片确诊为新鲜Tossy Ⅲ型肩锁关节脱位.受伤至手术时间2～6 d.     

双 Endobutton 钢板治疗肩锁关节脱位的疗效

2010年1月～2013年11月,我们应用双 Endobutton 钢板重建肩锁关治疗25例 Rockwood Ⅲ～Ⅴ型肩锁关节脱位患者,疗效良好,报道如下。     

钛缆经喙突-锁骨固定技术治疗肩锁关节损伤

[目的]探讨Tossy分类Ⅲ型的肩锁关节损伤手术治疗新方法.[方法]通过回顾性研究,对比两种方法治疗TossyⅢ型肩锁关节脱位患者共48例的疗效.病例按手术方法不同分两组:钛缆经喙突、锁骨固定组(25例),及钩钢板治疗组即对照组(23例);术中对所有病例均不过多的暴露和修复损伤的喙锁韧带.所有病例12～19个月后取出内植物,对所有患者的临床症状、体征和影像学表现进行随访,对结果进行统计学分析.[结果]平均随访时间为3.5年,钛缆经喙突、锁骨固定组:Constant-Murley评分平均(93.4±8.3)分,Karlsson评分优良率96%,并发症发生率4%;钩钢板固定组:Conslant-Mudey评分平均(88.1±9.5)分,Karlsson评分优良率87%,并发症发生率13%.经方差齐性检验和独立样本t检验,两组Constant-Murley评分有明显统计学差异,P＜0.05.[结论]钛缆经喙突-锁骨固定技术是治疗肩锁关节脱位的一种符合生理学原理、简便和效果良好的方法.不过多的暴露和修复喙锁韧带对新鲜损伤病例愈合无明显影响却能减少损伤.     

The Modified Bristow Procedure for Recurrent Anterior Dislocation of the Shoulder: Results and Complications

Seventeen out of eighteen patients, who underwent the modified Bristow operation for anterior recurrent dislocation of the shoulder, were followed up after a mean observation time of 52 months. Fourteen patients were satisfied with the result. There were no redislocations. The principal limitation in range of motion was loss of some external rotation. Eight patients had non-union between the bone transplant and the glenoid rim, and four of these had complications related to the screw. Two had loosenings and two had fractures of the screw. Non-union without screw complications appeared not to influence the end result. The reasons for the complications seem to be technical problems concerning fixation and bone union of the coracoid process.     

锁骨钩钢板内固定术后肩部疼痛和外展受限的分析

目的探讨采用锁骨钩钢板内固定治疗锁骨远端骨折和肩锁关节脱位术后并发肩部疼痛和肩关节外展受限的原因。方法将60例锁骨远端骨折和肩锁关节脱位患者随机分为A、B两组。锁骨钩钢板外侧钩的安置采用两种不同方式：A组（30例）患者术中仅显露锁骨骨折断端及肩锁关节,不显露肩峰,锁骨钩钢板外侧钩于肩锁关节后方盲插入肩峰下进行固定;B组（30例）患者同时显露肩峰,将锁骨钩钢板外侧钩紧贴肩峰于骨膜下插入进行固定,以减少钢板钩部与肩峰之间软组织嵌入。对两组术后出现患侧肩关节疼痛不适及外展受限发生率进行组间对比分析。结果 55例患者获得12-24个月随访,5例失访。肩关节疼痛及外展轻度受限B组28例中出现3例,发生率为10.7%;A组27例中出现9例,发生率为33.3%,两组比较差异有统计学意义（P〈0.05）。结论术中充分显露肩峰,紧贴肩峰插入锁骨钩钢板外侧钩,使外侧钩部与肩峰紧密贴合,可减少其间软组织嵌入和肩峰与钢板钩部撞击,从而减少术后肩关节疼痛及外展受限等并发症的发生率。     

Ⅲ度肩锁关节脱位漏诊6例分析

2004年1月～2007年12月,我院共收治AllmanⅢ度肩锁关节脱位36例,其中漏诊6例,现将漏诊原因分析如下。 1材料与方法 1．1病例资料本组6例,男3例,女3例,年龄14～55岁。左侧2例,右侧4例,合并同侧锁骨骨折3例,脱位侧肩部擦伤4例。多发性骨折2例,其中合并同侧多发性肋骨骨折伴胸腔积液、第5掌骨骨折1例,另合并同侧肱骨骨折及腓肠肌部分断裂1例。发现漏诊时间为初诊后2～14d。     

锁骨钩钢板治疗Ⅲ型肩锁关节脱位

2001年10月～2004年4月,笔者应用锁骨钩钢板治疗26例Ⅲ型肩锁关节脱位,并对所有患者进行了随访,取得了较满意的疗效.     

Polymethylmethacrylate causes prolonged pulmo-nary hypertension during fat embolism: A study in sheep

Background?Fat embolism (FE), the release of bone marrow contents into the circulation and the subsequent cardiovascular changes, is still a potentially fatal com-plication during orthopedic surgery. Different causative factors have been suggested, but the exact pathomechanism of FE still remains unclear. We investigated the role of polymethylmethacrylate (PMMA) in FE during vertebroplasty in sheep.

Methods?In 8 sheep, two vertebral bodies were augmented alternatively with PMMA or bone wax. Pulmonary and cardiovascular parameters were monitored during the procedure.

Results?The peak response was similar for both groups and characterized by hypotension, a drop in cardiac output and pulmonary hypertension. However, the recovery in pulmonary arterial pressure and pulmonary vascular resistance was quicker in the wax group.

Interpretation?The injection of PMMA may cause prolonged pulmonary hypertension during vertebro-plasty and also arthroplasty. Surgeons should be aware of this potential cardiovascular complication, especially in patients with impaired pulmonary and cardiovascular function.

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