CAJ | 학술논문

目的探讨锁骨远端切除联合腱外侧半反转辅助异体肌腱移植重建喙锁韧带治疗肩锁关节脱位的术后中长期疗效. 方法回顾性分析2006年1月至2008年1月间采用锁骨远端切除联合腱外侧半反转辅助异体肌腱移植重建喙锁韧带手术治疗的54例肩锁关节脱位患者资料,男34例,女20例;年龄21.7～64.1岁,平均40.4岁.受伤至手术时间平均为12.2 d(3 ～20 d).肩锁关节脱位按Rockwood分型:Ⅲ型6例,Ⅳ型6例,Ⅴ型42例.末次随访时采用疼痛视觉模拟评分(VAS)、美国肩肘外科医师评分(ASES)评分及Constant-Murley评分评价患者肩关节功能,同时摄肩关节X线片以评估肩锁关节复位是否丢失. 结果术后54例患者平均随访64.2个月(48.6～92.2个月).末次随访时患者肩关节前屈上举平均为170.0°(160°～ 180°),体侧外旋为57.8°(40°～ 80°),内旋至T8水平(T2～T12).VAS评分平均为0.7分(0～4分),平均ASES评分为90.4分(81.7 ～100.0分),Constant-Murley 评分平均为90.9分(83.0～100.0分).12例(22.2％)患者出现肩锁关节压痛;6例(11.1％)Ⅴ型损伤患者出现部分复位丢失;无一例患者出现完全复位丢失. 结论采用锁骨远端切除联合腱外侧半反转辅助异体肌腱移植重建喙锁韧带的方法治疗重度肩锁关节脱位,患者的肩关节功能恢复满意,中长期疗效较好,多数患者肩锁关节保持稳定.
목적 탐토쇄골원단절제연합건외측반반전보조이체기건이식중건훼쇄인대치료견쇄관절탈위적술후중장기료효. 방법 회고성분석2006년1월지2008년1월간채용쇄골원단절제연합건외측반반전보조이체기건이식중건훼쇄인대수술치료적54례견쇄관절탈위환자자료,남34례,녀20례;년령21.7～64.1세,평균40.4세.수상지수술시간평균위12.2 d(3 ～20 d).견쇄관절탈위안Rockwood분형:Ⅲ형6례,Ⅳ형6례,Ⅴ형42례.말차수방시채용동통시각모의평분(VAS)、미국견주외과의사평분(ASES)평분급Constant-Murley평분평개환자견관절공능,동시섭견관절X선편이평고견쇄관절복위시부주실. 결과 술후54례환자평균수방64.2개월(48.6～92.2개월).말차수방시환자견관절전굴상거평균위170.0°(160°～ 180°),체측외선위57.8°(40°～ 80°),내선지T8수평(T2～T12).VAS평분평균위0.7분(0～4분),평균ASES평분위90.4분(81.7 ～100.0분),Constant-Murley 평분평균위90.9분(83.0～100.0분).12례(22.2％)환자출현견쇄관절압통;6례(11.1％)Ⅴ형손상환자출현부분복위주실;무일례환자출현완전복위주실. 결론 채용쇄골원단절제연합건외측반반전보조이체기건이식중건훼쇄인대적방법치료중도견쇄관절탈위,환자적견관절공능회복만의,중장기료효교호,다수환자견쇄관절보지은정.
Objective To investigate the mid-and long-term outcomes of reconstruction of coracoclavicular ligament by excision and semi-inversion of conjoined tendon at the distal clavicle and allograft tendon transfer in the treatment of acromioclavicular separation.Methods From January 2006 to January 2008,54 patients with acromioclavicular separation were treated by reconstruction of coracoclavicular ligament by excision and semi-inversion of conjoined tendon at the distal clavicle and allograft tendon transfer.They were 34 men and 20 women,with a mean age of 40.4 years (range,from 21.7 to 64.1 years).The mean time from injury to surgery was 12.2 days (range,from 3 to 20 days).According the Rockwood classification,6 cases were type Ⅲ,6 type Ⅳ and 42 type Ⅴ.All the patients were routinely followed up after the surgery.The visual analogue scale (VAS),American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores were used to evaluate the postoperative shoulder function.Postoperative radiograph was taken for each patient to evaluate the loss of reduction of the acromioclavicular joint.Results The mean follow-up time was 64.2 months (range,from 48.6 to 92.2 months).At the final follow-up,the average forward elevation was 170.0° (range,from 160° to 180°),external rotation 57.8° (range,from 40° to 80°) and internal rotation T8 level (range,from T2 to T12),respectively.The average VAS,ASES and Constant-Murley scores were 0.7 (range,from 0 to 4),90.4 (range,from 81.7 to 100.0) and 90.9 (range,from 83.0 to 100.0),respectively.Tenderness on the distal clavicle was found in 12 patients (22.2％).Partial loss of reduction was found in 6 patients with type Ⅴ fracture (11.1％).No complete loss of reduction was found in any case.Conclusion Most patients may obtain good shoulder function and no loss of reduction at mid-and long-term follow-ups after their acromioclavicular separation has been treated by reconstruction of coracoclavicular ligament by excision and semi-inversion of conjoined tendon at the distal clavicle and allograft tendon transfer.