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Effectiveness of arthroscopic distal clavicle resection for symptomatic acromioclavicular joint arthritis

Objective To investigate the effectiveness of arthroscopic distal clavicle resection for the symptomatic acromioclavicular joint arthritis. MethodsThe clinical data of 14 patients with symptomatic acromioclavicular joint arthritis treated by arthroscopic indirect distal clavicle resection between January 2020 and March 2021 were retrospectively analyzed. There were 5 males and 9 females with an average age of 46.3 years (range, 18-57 years). The 4 cases of left shoulder and 10 cases of right shoulder were accompanied with acromial impingement, without the history of shoulder trauma. The average disease duration was 20.4 months (range, 9-48 months), and the average visual analogue scale (VAS) score was 7.6 (range, 5-9) preoperatively. The results were evaluated using the University of California Los Angeles (UCLA) shoulder rating score before and after operation, further, the patient satisfaction rate was also calculated. Results All 14 patients were followed up 5-18 months, with an average of 13 months. There was no postoperative pain of acromioclavicular joint in 12 patients; 1 case had occasional mild pain, which could be controlled by painkillers. Moreover, there was only 1 acromioclavicular joint subluxation due to early fitness training at 2 weeks postoperatively, and the symptoms gradually relieved after 1 month of conservative treatments. The UCLA score was 22.1±6.2 preoperatively, which improved to 30.2±3.4 at last follow-up, showing significant difference (t=5.359, P<0.001). The patient satisfaction rate was 92.9%, with 12 excellent cases, 1 good case, and 1 fair case. Conclusion Arthroscopic distal clavicle resection for symptomatic acromioclavicular arthritis is a safe, reliable, and repeatable procedure.

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。

C臂X线机引导下双Endobutton钢板微创治疗肩锁关节脱位

目的总结C臂X线机引导下双Endobutton钢板微创治疗RockwoodⅢ型及以上肩锁关节脱位的疗效。 方法2010年1月-2012年6月，于C臂X线机引导下采用双Endobutton钢板微创治疗肩锁关节脱位21例。男16例，女5例；年龄19～46岁，平均29.8岁。致伤原因：摔伤14例，交通事故伤7例。损伤至手术时间为5～12 d，平均8.3 d。根据Rockwood分型标准：Ⅲ型14例，Ⅳ型5例，Ⅴ型2例。术前肩关节疼痛视觉模拟评分（VAS）为（7.82±0.21）分，Constant评分为（35.3±4.6）分。 结果术后切口均Ⅰ期愈合，无神经、血管损伤等手术相关并发症发生。患者均获随访，随访时间12～14个月，平均13.4个月。X线片复查示，锁骨远端高度均达到解剖复位。术后1周及1、12个月Constant评分分别为（85.2±5.6）、（90.1±3.5）、（96.3±2.8）分；活动状态下VAS评分分别为（4.33±0.34）、（2.12±0.26）、（0.85±0.16）分；术后各时间点以上两指标均较术前显著改善（P＜0.05）。 结论C臂X线机引导下双Endobutton钢板微创治疗Rockwood Ⅲ型及以上肩锁关节脱位安全、有效。

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.

可吸收螺钉改良Dewar术治疗陈旧性Ⅲ度肩锁关节脱位

肩锁钩钢板治疗肩锁关节脱位的临床应用

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。

三种内固定方法治疗肩锁关节脱位的疗效分析

锁骨钩钢板治疗Ⅲ度肩锁关节脱位

跖肌腱移植重建喙锁及肩锁韧带结合钢板固定治疗肩锁关节脱位

目的总结应用跖肌腱重建喙锁及肩锁韧带结合钩钢板固定治疗肩锁关节脱位的临床效果。 方法2012年8月－2014年8月，采用跖肌腱“8”字固定重建喙锁及肩锁韧带联合钩钢板固定治疗9例急性肩锁关节脱位患者。男7例，女2例；年龄21～51岁，平均31.7岁。Rockwood分型：Ⅲ型3例，Ⅳ型5例，Ⅴ型1例。受伤至手术时间2～5 d，平均3.3 d。术后随访患者Constant-Murley功能评分、肩关节活动度、复位维持情况及疼痛视觉模拟评分（VAS）。 结果9例均获随访，随访时间12～26个月，平均17.4个月。术后无肩峰撞击、肩峰下骨溶解、再脱位等并发症发生；末次随访时患侧肩关节前屈上举（178.8±1.1）°。末次随访时Constant-Murley评分健患侧比较差异无统计学意义（t=1.142，P=0.312）；VAS评分较术前显著改善（t=3.623，P=0.002）。术后1周及末次随访时患侧喙锁间隙距离均较术前显著改善（t=3.294，P=0.004；t=3.237，P=0.005）；术后1周与末次随访比较差异无统计学意义（t=0.724，P=0.635）。 结论跖肌腱移植“8”字重建喙锁及肩锁韧带联合钩钢板治疗肩锁关节脱位符合生物力学要求，临床疗效满意且学习曲线短。