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Application of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique for acute acromioclavicular joint dislocation

Objective To investigate the effectiveness of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique in the treatment of acute acromioclavicular joint dislocation. Methods A clinical data of 28 patients with acute acromioclavicular joint dislocation who met the selection criteria and admitted between June 2018 and December 2021 was retrospectively analyzed. There were 18 males and 10 females, with an average age of 47.7 years (range, 22-72 years). The causes of injury included falling (13 cases) and traffic accidents (15 cases). The acromioclavicular joint dislocation was rated as Rockwood type Ⅲ in 7 cases, type Ⅳ in 16 cases, and type Ⅴ in 5 cases. The time from injury to operation was 4-13 days, with an average of 9.5 days. The acromioclavicular joint dislocation was reconstructed with TightRope system and high-strength wire by Locking-Loop methods during operation. The operation time and complications were recorded. Visual analogue scale (VAS) score, Constant-Murley score, and active range of motion of shoulder (forward flexion and upward lift, abduction and upward lift, and external rotation) were recorded before operation and at 12 months after operation to evaluate the functional recovery of shoulder. The loss of acromioclavicular joint reduction was assessed by comparing the coracoclavicular distance (CCD) based on the anteroposterior X-ray films at 3 days and 12 months after operation. Results The operation time was 58-100 minutes (median, 85 minutes). All incisions healed by first intention. All patients were followed up 12 months. During follow-up, 2 patients developed shoulder adhesion, which recovered after rehabilitation exercise. At 12 months after operation, the VAS score was significantly lower, the Constant-Murley score was significantly higher, and the range of motion of the shoulder joint (forward flexion and upward lift, abduction and upward lift, and external rotation) significantly increased when compared with preoperative ones (P<0.05). X-ray films showed that the CCD was 8.4 (7.3, 9.4) and 9.2 (8.1, 10.1) mm at 3 days and 12 months after operation, respectively, with a significant difference (Z=−4.665, P<0.001). During follow-up, there was no complication such as infection, titanium plate entrapment, fracture, internal fixation failure, or redislocation. ConclusionThe treatment of acute acromioclavicular joint dislocation with TightRope system combined with Locking-Loop biplane anatomical reconstruction has the advantages of small incision, joint reduction under direct vision, high fixation strength, and low incidence of postoperative complications, which can effectively relieve the pain of patients’ shoulder joint and facilitate the recovery of shoulder joint function.

REPAIR OF ACROMIO-CLAVICULAR DISLOCATION BY TRANSPOSITION OF SHORT HEAD OF BICEPS BRACHII MUSCLE

The short head of the biceps brachii muscle was removed from its origin with a thin piece of bone from the coronoid process and was transposed to the dislocated clavicle. From the action of muscle contraction from the biceps brachii muscle, the dislocated clavicle would be pulled downward. This method of repair was satisfactory in4 cases of acromioclavicular dislocation. Results obtained from the follow-up, there was no recurrence of dislocation, and the function and muscle power of the shoulder were completely normal.

锁骨钩钢板的临床应用及并发症分析

目的 总结以锁骨钩钢板内固定治疗Neer Ⅱ型锁骨远端骨折和Tossy Ⅲ型肩锁关节脱位的临床应用效果及并发症。 方法 2005 年8 月－ 2010 年2 月，以锁骨钩钢板内固定治疗Neer Ⅱ型锁骨远端骨折20 例和TossyⅢ型肩锁关节脱位28 例，对临床应用效果及术后并发症进行回顾性分析。其中男30 例，女18 例；年龄20 ～ 64 岁，平均33.5 岁。交通事故伤36 例，坠落伤12 例。受伤至手术时间为2 ～ 10 d，平均4.5 d。 结果 术后所有患者切口均Ⅰ期愈合。48 例均获随访，随访时间6 ～ 24 个月，平均13.6 个月。术后发生脱钩2 例、断钩1 例、锁骨应力性骨折1 例、异位骨化1 例、锁骨上皮神经损伤1 例、肩部出现异响不适3 例，均经再手术或对症处理治愈或好转。按洛杉矶加利福尼亚大学（UCLA）肩关节等级评分评定疗效，获优15 例，良27 例，可6 例，优良率87.5%。38 例于术后9 ～ 24 个月取出内固定物，未出现再骨折或肩锁关节再脱位情况。 结论 以锁骨钩钢板内固定治疗Neer Ⅱ型锁骨远端骨折和Tossy Ⅲ型肩锁关节脱位疗效良好，但需注意处理其并发症。

钢丝联合重建钢板治疗分离性肩锁关节脱位的近期疗效观察

【摘要】　目的　总结采用钢丝联合重建钢板治疗分离性肩锁关节脱位的临床近期疗效。　方法　2008年2月-2010年11月，采用钢丝联合重建钢板治疗分离性肩锁关节脱位4例。男2例，女2例；年龄24~45岁，平均年龄33.5岁。肩锁关节均呈分离性脱位，分离距离4.0~6.5 cm，平均5.2 cm。受伤至手术时间2~4 d。治疗后参照Karlsson评价标准，根据疼痛程度、上肢肌力、肩部活动度及X线片检查中肩锁关节间隙进行疗效评定。　结果　3例获随诊，随访时间2~12个月，平均5.6个月。X线片示肩锁关节位置正常，无钢板螺钉断裂、松动。术后2个月，按Karlsson标准评价疗效，获优1例，良2例。　结论　钢丝联合重建钢板治疗分离性肩锁关节脱位固定牢固，符合生物力学要求，可早期进行功能锻炼，获得良好的临床效果。

锁骨钩钢板固定结合喙锁韧带重建治疗陈旧性肩锁关节脱位

目的 总结锁骨钩钢板固定结合喙锁韧带重建治疗陈旧性肩锁关节脱位的临床疗效。 方法 2003 年6 月－ 2008 年12 月，采用锁骨钩钢板固定结合喙锁韧带重建治疗17 例陈旧性肩锁关节脱位。男11 例，女6 例；年龄16 ～ 53 岁，平均39 岁。均为直接暴力致伤。左侧7 例，右侧10 例。Rockwood 分型：Ⅲ型14 例，Ⅳ型2 例，Ⅴ型1 例。受伤至手术时间为14 ～ 55 d，平均23 d。 结果 术后切口均Ⅰ期愈合。肩锁关节脱位均纠正，无神经、血管损伤等并发症发生。术后患者均获随访，随访时间6 ～ 15 个月，平均12 个月。术后3 ～ 6 个月取出锁骨钩钢板，无再脱位发生。术后6 个月按Karlsson 疗效评价标准：优12 例，良4 例，差1 例，优良率94.1%。 结论 锁骨钩钢板固定结合喙锁韧带重建具有操作简便、创伤小、固定可靠、可早期功能锻炼等优点，是治疗陈旧性肩锁关节脱位的一种有效方法。

可吸收螺钉改良Dewar术治疗陈旧性Ⅲ度肩锁关节脱位

钩钢板治疗锁骨外侧端骨折伴肩锁关节脱位

锁骨钩钢板治疗Ⅲ度肩锁关节脱位

带线骨锚钉治疗Tossy Ⅲ型肩锁关节脱位

目的 总结应用带线骨锚钉内固定治疗Tossy Ⅲ型肩锁关节脱位的效果。 方法 2007 年10 月－2010 年6 月，对27 例Tossy Ⅲ型肩锁关节脱位患者应用带线骨锚钉行内固定并韧带修复治疗。男19 例，女8 例；年龄21 ～ 59 岁。运动伤11 例，摔伤10 例，交通事故伤4 例，高处坠落伤2 例。受伤距手术间8 h ～ 5 d，平均3 d。 结果 术后切口均Ⅰ期愈合，无感染、渗液等并发症发生。27 例均获随访，随访时间9 ～ 41 个月，平均20 个月。术后6 个月X 线片示肩锁关节复位良好。术后9 个月患肩关节活动范围：向前上举140 ～ 160°，后伸35 ～ 40°；外展上举160 ～ 170°，内收25 ～ 30°；上臂紧贴胸壁内旋60 ～ 70°，外旋40 ～ 45°。外展上举肌力5 级24 例，4+ 级3 例。术后9 个月根据Karlsson 等关节功能评价标准，获优21 例，良6 例，优良率为100%。 结论 应用带线骨锚钉固定肩锁关节脱位，固定可靠，有助于术后早期功能锻炼，疗效良好。

TRIPLE ENDOBUTTON TECHNIQUE FOR REPAIR OF CHRONIC COMPLETE ACROMIOCLAVICULAR JOINTDISLOCATIONS

【Abstract】 Objective To evaluate the early result of tri ple Endobutton technique for reconstructing coracoclavicularligament of chronic complete acromioclavicular joint dislocations. Methods Between January 2009 and June 2010, 14 patients with chronic complete acromioclavicular joint dislocations were treated with tri ple Endobutton technique for reconstructing coracoclavicular ligament. There were 10 males and 4 females with a mean age of 38.5 years (range,26-52 years). Injury was caused by traffic accident in 7 cases,by falling in 5 cases，and by bruise in 2 cases. The average time was 47 days from injury to the operation (range,29-75 days). All patients had pain and activity restriction. The X-ray films showed complete dislocation of acromioclavicular joint. According to Allman’s type, all cases were classified as III degree complete dislocations. Results At postoperation, wound healed by first intention with no early complication of infection or neurovascular injury. All patients were followed up 18.3 months on average (range,13-30 months). Acromioclavicular joint subluxation occurred in 1 patient at 1 week after operation, and no redislocation or other complication occurred in the other patients. American Shoulder and Elbow Surgeons (ASES) score was 90.8 ± 4.1 at last follow-up, showing significant difference when compared with the preoperative score (65.3 ± 4.4) (t= —17.57，P=0.00); Constant-Murley score was 91.7 ± 3.9, showing significant difference when compared with preoperative one (71.5 ± 4.6) (t=—75.02，P=0.00). The definite answer in Simple Shoulder Test (SST) averaged 9.7 (range,7-12). Conclusion The tri ple Endobutton technique for reconstructing coracoclavicular ligament is an effective method in treatment of chronic complete acromioclavicular joint dislocations. The short-term results are satisfactory.