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初步临床疗效观察

目的探讨全关节镜下双Endobutton纽扣钢板固定技术治疗急性肩锁关节脱位重建喙锁韧带的疗效。方法2007年8月至2009年3月间,肩关节镜下使用双Endobutton纽扣钢板固定技术行喙锁韧带重建术治疗RockwoodⅢ型新鲜肩锁关节脱位患者共8例,其中男6例,女2例,年龄22～53岁,有明确外伤病史1～15d,平均4.6d。手术均在肩关节镜下用2个Endobutton纽扣钢板和4股5号爱惜邦缝线行肩锁关节复位后喙锁韧带重建术。术后悬吊制动4～6周再行康复锻炼,术后3个月、半年和1年分别进行随访,并拍摄X线片,用VAS评分和Constant评分进行疗效评价。结果8例患者均取得了3个月以上的随访,平均随访11个月。其中1例术后3个月时仍有肩锁关节疼痛,肩关节活动范围轻度受限,8例患者Constant评分平均为93.9分,VAS评分平均为1.75,术后6个月时均无明显疼痛,对肩关节功能均满意,X光片显示无再发脱位和半脱位。结论肩关节镜下应用双Endobutton纽扣钢板固定技术行喙锁韧带重建术是治疗RockwoodⅢ型新鲜肩锁关节脱位的一种有效方法,此种手术方式有效提供了早期机械稳定性,为韧带的愈合和瘢痕形成提供了条件,术后对锁骨运动中的旋转机制没有影响。手术创伤小,恢复快,并发症少。严格掌握手术适应证,熟练的关节镜下操作技术,对镜下正常解剖结构的认识和骨隧道的正确定位是手术成功的关键。

The early results of total arthroscopic double Endobutton technique for acute acromioclavicaular joint dislocation

Objective To evaluate the early result of low-profile doublemetallic endobutton technique reconstructing coracoclavicular ligament of acute acromioclavicaular 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 acromioclavicaular joint dislocation （ Rockwood type m ） were treated in author＇s department. They suffered from this disease for about 4.6 days in average （ 1 - 15 days）. 2 endobuttons and 4 strands No. 5 Ethibond suture were used to reconstruct coracoclavieular ligament after acromioelavicaular joint reduction. At the latest follow-up evaluation, radiographic analysis and the Contant scores and VAS （Visual Analog Scale） were used to provide a final evaluation of shoulder function for 3 months, 6 months and 12 months. Results All of 8 patients have type m acute fresh aeromioclavicular dislocations according to the Rockwood classification system were followed up for more than 3 months, 11 months on average. The Constant sore averaged 93.9, with a mean VAS pain score of 1.75. There were no patients with A-C joint redislocation during this period after analyzing X-ray, but 1 patient＇s pain score was 4 （VAS） by 3 months. The operation was satisfactory for 8 cases. Most patients returned to their preinjury activity level and resumed to work by 3 months postoperatively. Conclusions Total arthroscopie double endobutton technique for reeonsetruction of coracoclavicular ligment is an effective approach to treatment of fresh Rockwood HI acromioclavicular dislocation. It provides early mechanical stability, which helps the ligment to heal and the scar tissue to form. It does not affect the rotating mechanism in the movement of the clavicle postoperatively. Minimally invasive, this approach enjoys early recovery and less complication. Precise positioning of the bone tunnel is essential for the success of the procedure.