同种异体肌腱联合锁骨钩钢板重建喙锁、肩锁韧带治疗肩锁关节脱位的临床研究

Allogeneic tendon graft united with hook plate for reconstruction of coracoclavicular and acromioclavicular ligaments in acromiodavicular dislocation

摘要:

目的  探讨应用同种异体肌腱一期重建喙锁和肩锁韧带联合锁骨钩钢板固定治疗肩锁关节脱位的技术方法和临床疗效。方法  选取2011年3月-2014年6月应用同种异体肌腱联合锁骨钩钢板重建喙锁、肩锁韧带治疗肩锁关节脱位的14例患者，包括Rockwood Ⅲ型肩锁关节脱位3例，Ⅳ型肩锁关节脱位5例，Ⅴ型肩锁关节脱位6例。所有患者于术后6～12个月拆除内固定锁骨钩钢板，通过X线评价肩锁关节复位维持情况、调查患者总体满意度，使用上肢功能障碍评分（DASH）和Constant-Murley肩关节评分来评价患者肩功能。结果  术后随访10～18个月，平均13个月。术后拆除内固定锁骨钩钢板后，复位无明显丢失，总体满意度为81.3%。内固定拆除术前Constant-Murley评分86～95分，平均（91.6±3.8）分；术后末次随访Constant-Murley评分85～96分，平均（93.5±4.2）分，两者比较差异无统计学意义（P >0.05）。内固定拆除术前DASH评分4～11分，平均（6.6±2.9）分；术后末次随访DASH评分4～10分，平均（6.9±2.4）分，两者比较差异无统计学意义（P >0.05）。结论  应用同种异体肌腱联合锁骨钩钢板一期修复重建喙锁和肩锁韧带治疗Ⅲ～Ⅴ型肩锁关节脱位，可以维持肩锁关节的良好复位，保证韧带的重建效果，恢复患者肩功能，是一种行之有效的治疗方法。

Abstract:

Objective To introduce and evaluate a method for reconstruction of coracoclavicular and acromioclavieular ligaments using allogeneic tendon graft united with hook plate in the management acromioclavicular joint dislocation. Methods Between March 2011 and June 2014, 14 cases of acromioclavicular joint dislocation were treated with allogeneic tendon graft united with hook plate to reconstruct the coracoclavicular and acromioclavicular ligaments, which included 3 cases of Rockwood type Ⅲ, 5 cases of type Ⅳ and 6 cases of type Ⅴ. After the removal of the hook plates in 6-12 months postoperatively, maintenance of the reduced acromioclavicular joint, patients' satisfaction, DASH and Constant-Murley shoulder scores were documented during follow-up evaluation. Results All the patients were followed up for 10-18 months (mean 13 months). After the removal of the hook plates, none of the reduced acromioclavicular joints had redislocation on X-ray evaluation. The overall satisfaction rate was 81.3%. There was no significant difference in the mean Constant-Murley score [preoperative (91.6 ± 3.8) vs postoperative (93.5 ± 4.2)] or mean DASH score [preoperative (6.6 ± 2.9) vs postoperative (6.9 ± 2.4)] before and after the removal of the hook plates (P > 0.05). Conclusions Allogeneic tendon graft united with hook plate is a reliable technique for reconstruction of coracoclavicular and acromioclavicular ligaments for the treatment of Rockwood type Ⅲ-Ⅴ acromiodavicular dislocation. It can maintain good reduction of acromioclavicular joint, ensure the reconstructive effect of the ligaments and restore the stability and function of acromioclavicular joint.