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肩锁钩钢板治疗肩锁关节脱位的临床应用

CLINICAL STUDY ON SURGICAL REPAIR OF ACUTE ACROMIOCLAVICULAR DISLOCATION BY MODIFIED WEAVER-DUNN TECHNIQUE

Objective To investigate the clinicalvalue of modified Weaver-Dunn technique in repair of acute acromioclavicular dislocation. Methods From January 1993 to December 1998, 18 cases of acromioclavicular dislocation were treated bymodified Weaver-Dunn technique, and other 17 cases of the same suffering were treated by tension band fixation of the acromioclavicular joints. All of the patients were followed up for 12-36 months before clinical evaluation of the functionof shoulder joints, according to University of Pennsylvanian Shoulder Score System. Results In short term, the shoulder joints recovered much more rapidly in the cases repaired by modified Weaver-Dunn technique; 12, 24 and 36 months after operation, the scores of the cases repaired by modified Weaver-Dunn technique were (1897±67), (193.7±3.6) and (194.7±3.4) respectively according to the Shoulder Score System, while those of the cases treated by tension band fixation were (167.3±7.8), (170.2±6.3) and (165.6±5.9) respectively. The above data indicated that there was significant difference between two groups (P＜0.05). Conclusion The modified Weaver-Dunn technique was a better surgical approach than tension band fixation for repair of acute acromioclavicular dislocation.

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。

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.

锁骨钩钢板治疗Ⅲ度肩锁关节脱位

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。

锁骨钩钢板结合锚钉治疗肩锁关节脱位22例

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.

带骨块喙肩韧带内移加锁骨钩钢板固定治疗 Tossy Ⅲ型肩锁关节脱位

目的  总结采用带肩峰骨块喙肩韧带内移加锁骨钩钢板固定治疗 Tossy Ⅲ型肩锁关节脱位的近期疗效。  方法  2003年6月－2008年3月，采用带肩峰骨块喙肩韧带内移重建喙锁韧带、肩锁关节锁骨钩钢板固定治疗35例Tossy Ⅲ型肩锁关节脱位。男24例，女11例；年龄17～58岁，平均32岁。车祸伤21例，摔伤10例，高处坠落伤4例。左侧 13 例，右侧 22 例。新鲜脱位 26 例，陈旧性脱位 9 例。受伤至手术时间 2 ～ 30 d，平均 9 d。  结果  术后切口Ⅰ期愈合 34 例，延期愈合 1 例。患者均获随访，随访时间 10 ～ 36 个月，平均 18 个月。术后钢板无松动、断裂，去除内固定后无肩锁关节再脱位、肩周肌肉萎缩及肩周炎发生。术后 10 个月肩关节功能参照 Lazzcano 标准评定：获优 31 例，良 4 例，优良率100%。   结论  采用带肩峰骨块喙肩韧带内移重建喙锁韧带、联合锁骨钩钢板固定治疗Tossy Ⅲ型肩锁关节脱位，手术操作简便，对肩部生理功能影响小，韧带重建可靠，内固定牢固，近期疗效满意。