全关节镜下双纽扣钢板固定技术治疗急性肩锁关节脱位的康复护理

目的探讨应用全关节镜下双纽扣钢板固定技术治疗急性肩锁关节脱位的康复护理。方法2007年8月至2009年3月，对8例肩锁关节脱位的患者进行肩关节镜下双纽扣钢板固定技术行喙锁韧带重建，术后制定系统的康复护理计划、分阶段进行肢体功能康复锻炼，在确保安全的前提下督促患者尽早进行主动和被动功能锻炼，定期随访。术后3个月、6个月和1年分别进行随访，用Constant评分和疼痛视觉模拟评分（VAS评分）进行疗效评价，并拍摄X线片确定有无再发脱位及半脱位。结果8例患者均获得3个月以上随访，平均7．2个月。术后3个月Constant评分平均为93．9分，VAS评分平均为1．75分，其中1例仍有肩锁关节疼痛，肩关节活动范围轻度受限；术后6个月时所有患者均无明显疼痛，对肩关节功能均满意，X线片显示无再发脱位。结论肩关节镜下应用双纽扣钢板固定技术行喙锁韧带重建术是治疗肩锁关节脱位的一种有效方法，术后的康复治疗与手术同等重要，完善的术后康复计划是肩关节达到良好功能恢复的必备条件，也是提高患者满意度的重要措施。

Rehabilitation nursing care of double endo-button technique under total arthroscope for acute acromiodavicular joint dislocation

Objective To evaluate the rehabilitation nursing care of double endo-button technique under total arthroscope for acute acromioclavicular joint dislocation. Methods From August 2007 to March 2009, 8 cases （8 shoulders, 6 males and 2 females, 22 - 53 years old, mean age 34. 4 ） with acute acromioclavicular joint dislocation （Rockwood type III） were treated in author＇s hospital. After surgery we made systemic rehabilitation care plan, phased into the body functional rehabilitation exercises, under the premise of ensuring safety of patients as soon as possible to urge the active and passive functional exercise, regular follow-up. Radiographic analysis and the Constant scores and VAS （ Visual Analogue Scale） were used to provide a final evaluation of shoulder function for 3 months, 6 months and 12 months after operation. Results All of 8 patients were followed up for more than 3 months（ average 7.2 months）. The Constant score averaged 93.9, with a mean VAS score of 1.75. There were no patients with A-C joint re-dislocation during this period after analyzing X-ray, but VAS score of 1 patient was 4 by 3 months. The operation for 8 cases was satisfactory. Most patients returned to their pre-injury activity level. Conclusions Total arthroscopic double endo-button technique for reconstruction of coracoclavicular ligament is an effective approach to treatment of fresh Rookwood Ⅲ acromioclavicular dislocation. This approach enjoys earlier recovery and less complication. Postoperative rehabilitation nursing is as important as surgery, not only for good functional recovery, but also for patient satisfaction.