中华肩肘外科电子杂志
中華肩肘外科電子雜誌
중화견주외과전자잡지
Chinese Journal of Shoulder and Elbow (Electronic Edition)
2015年
1期
18-23
,共6页
宋哲%张堃%朱养均%李忠%庄岩%魏巍%杨娜
宋哲%張堃%硃養均%李忠%莊巖%魏巍%楊娜
송철%장곤%주양균%리충%장암%위외%양나
肩锁关节%脱位%Endobutton 技术
肩鎖關節%脫位%Endobutton 技術
견쇄관절%탈위%Endobutton 기술
Acromioclavicular joint%Dislocation%Endobutton technique
目的：探讨应用 Endobutton 带袢钢板技术治疗 Rockwood Ⅲ型肩锁关节脱位的手术方法及疗效。方法回顾性分析2010年6月至2013年6月收治的 Rockwood Ⅲ型肩锁关节脱位患者21例,其中男性14例、女性7例；年龄19~52岁,平均31.2岁。21例患者均Ⅰ期接受手术治疗,通过 X 线片观察术后肩锁关节脱位修复情况以及内固定牢固程度,并定期按 Constant 评分和 Karlsson疗效评价标准对肩锁关节功能进行评估。结果21例患者均获得16.2(12~36)个月随访。随访结果如下,Constant 评分：平均92.4(70~100)分；Karlsson 疗效评价标准：优16例(76.2%)、良4例(19.0%)、差1例(4.7%),优良率达95.2%。结论应用 Endobutton 带袢钢板技术治疗 RockwoodⅢ型肩锁关节脱位具有临床效果好、手术创伤小、并发症少、不需二次手术等优点。
目的：探討應用 Endobutton 帶袢鋼闆技術治療 Rockwood Ⅲ型肩鎖關節脫位的手術方法及療效。方法迴顧性分析2010年6月至2013年6月收治的 Rockwood Ⅲ型肩鎖關節脫位患者21例,其中男性14例、女性7例；年齡19~52歲,平均31.2歲。21例患者均Ⅰ期接受手術治療,通過 X 線片觀察術後肩鎖關節脫位脩複情況以及內固定牢固程度,併定期按 Constant 評分和 Karlsson療效評價標準對肩鎖關節功能進行評估。結果21例患者均穫得16.2(12~36)箇月隨訪。隨訪結果如下,Constant 評分：平均92.4(70~100)分；Karlsson 療效評價標準：優16例(76.2%)、良4例(19.0%)、差1例(4.7%),優良率達95.2%。結論應用 Endobutton 帶袢鋼闆技術治療 RockwoodⅢ型肩鎖關節脫位具有臨床效果好、手術創傷小、併髮癥少、不需二次手術等優點。
목적：탐토응용 Endobutton 대번강판기술치료 Rockwood Ⅲ형견쇄관절탈위적수술방법급료효。방법회고성분석2010년6월지2013년6월수치적 Rockwood Ⅲ형견쇄관절탈위환자21례,기중남성14례、녀성7례；년령19~52세,평균31.2세。21례환자균Ⅰ기접수수술치료,통과 X 선편관찰술후견쇄관절탈위수복정황이급내고정뢰고정도,병정기안 Constant 평분화 Karlsson료효평개표준대견쇄관절공능진행평고。결과21례환자균획득16.2(12~36)개월수방。수방결과여하,Constant 평분：평균92.4(70~100)분；Karlsson 료효평개표준：우16례(76.2%)、량4례(19.0%)、차1례(4.7%),우량솔체95.2%。결론응용 Endobutton 대번강판기술치료 RockwoodⅢ형견쇄관절탈위구유림상효과호、수술창상소、병발증소、불수이차수술등우점。
Background Acromioclavicular joint dislocation is a common injury which often occurs in heavy manual workers and young athletes.It is usually caused by collision of the shoulder on the ground.Acromioclavicular joint dislocation of Rockwood type Ⅲ often needs surgical treatment. There are several kinds of operation methods reported in the literature,but no universally accepted technique exists.From June 2010 to June 2013,21 patients of Rockwood type Ⅲ acromioclavicular joint dislocation were treated with Endobutton technique in our hospital,shoulder functional and radiological evaluations were performed and the outcome is encouraging.Methods (1 )General information:Twenty-one patients were included in this study.Patients were 14 males and 7 females. Nine cases were on the left side and 12 cases were on the right side.The age ranged from 1 9 to 52 with an average of 31.2 years.The causes were traffic injury in 8 cases,fall damage in 9 cases,sports injury in 2 cases and heavy object hit injury in 2 cases.All patients were diagnosed as acromioclavicular joint dislocation of Rockwood type Ⅲ without clavicle fracture,multiple fractures,closed chest injury and cerebral injury.The clinical presentations included pain over the lateral side of clavicle with its distal end protruding upward,tenderness and a feeling of floating;X-ray examinations revealed that the distal clavicle was higher than the acromion.21 cases were all fresh dislocations without neurovascular injuries;The operation time was 1-5 days after injury.(2)Operation method:After successful general anesthesia or cervical plexus block,the patient was in supine or “beach chair”position with head turned to the uninjured side.The straight incision was extended longitudinally from coracoid upward to the posterior edge of clavicle.The skin and subcutaneous tissue was incised layer by layer.The deltoid muscle was bluntly separated and the periosteum was stripped to expose acromioclavicular joint,distal clavicle and coracoid.The fascias of deltoid muscle and trapezius muscle were divided along the long axis of clavicle and the periosteum was stripped to expose the distal clavicle.The interal between deltoid and pectoralis major muscle was opened and the medial and lateral boarders of coracoid was prepared.The residual coraco-clavicle ligament was reserved.The articular space of acromioclavicular joint was examined and the ruptured fibrous cartilage disc was removed.After reduction of acromioclavicular joint,one Kirschner wire was drilled through the articular surface from the lateral end of acromion to provisionally keep the joint in place.A 1.0 mm guide pin was drilled from distal clavicle into the base of coracoid perpendicularly,3.5 mm canulated drill bit drilled a bone tunnel along the guiding pin.The distance from the surface of clavicle to the base of coracoid was measured with depth scale.The Endobutton was selected properly.A shuttle wire was used to pull the button loop out of clavicle and left the button under coracoid.The distal clavicle was reduced with compression.The loop was pulled upward and the other Endobutton without loop was put into the loop with acutenaculum.First,the Endobutton was laid on its side with sutures pierced through its two holes. Then the Endobutton was laid flat and made sure to attach to the base of coracoid without sliding.The sutures were tightened and knotted to make the Endobutton without loop fixed on the loop.The reconstruction of conoid ligament was finished.Then the suture on the coracoclavicular ligament was tightened and knotted.The wound was irrigated.The acromioclavicular joint capsule was repaired and the deltoid and trapezius muscle were reconstructed at the distal clavicle.The incision was closed layer by layer.(3 )Post-operative management and outcome evaluation:Antibiotics were given to prevent infection for 24-48 hours.The shoulder was protected by a sling for 1 -2 weeks.Pendulum exercise began after pain relief and the range of motion increased gradually.Only passive motion was permitted in the first 4 weeks and shoulder abduction or anteflexion was limited within 90°.Active motion including anteflexion,elevation and abduction began 4 weeks later.Lifting heavy objects should be avoided within 8 weeks after operation.Postoperative follow-up took place once a month in the first 3 months and then once every 3 months.Anteroposterior X-ray films,range of motion and muscle strength were included in the follow-up.The shoulder function was assessed at the last follow-up according to Constant-Murley score and Karlsson postoperative efficacy grading score.Results Twenty-one patients of this study were followed up for 12 - 36 months with a mean time of 1 6.2 months.All the incisions healed without any complication.Infection,neurovascular damage and secondary fracture were not occurred.One patient had plate sliding and redislocation without obvious pain.His shoulder had good activity and therefore he received no treatment.X-ray films revealed anatomical reduction and good internal fixation of acromioclavicular joint in other patients.Their shoulder joints restored normal activities with no or slight pain and the outcome were satisfactory.The shoulder function was assessed according to Constant score which was classified as pain (1 5 scores), daily activity (20 scores),range of motion (40 scores)and muscle strength (25 scores).The last scores of patients in this group were 70 - 100 with an average of 92.4,including pain 13.3 (5 - 1 5 ), daily activity 18.1(13-20),range of motion 37.8(28 -40)and muscle strength 23.3 (1 5 -25 ).The shoulder function was classified according to Karlsson evaluation criteria as follows:Excellent:painlessness,normal muscle strength,free activity and X-ray films revealed anatomical reduction of acromioclavicular joint or less than 5 mm of subluxation;Good:satisfaction,mild pain,dysfunction, medium muscle strength,90°-180°of range of motion and X-ray films revealed acromioclavicular joint dislocation;Bad:pain intensified at night,poor muscle strength,activity of shoulder joint was less than 90°in any direction and X-ray films revealed acromioclavicular joint dislocation.This group had 1 6 excellent cases (76.2%),4 good cases (1 9%)and 1 poor case (4.7%).The excellent and good rate was 95.2%.Conclusion Endobutton technique is a nonrigid method for the treatment of Rockwood type Ⅲ acromioclavicular joint dislocation with good outcome.This technique has some advantages such as simple operation,minimal invasive,anatomical and biomechanical reduction,little interference to the joint,less postoperative complications,early functional training,no necessity of reoperation for implant removal,etc.
