• 1 南通大學(xué)附屬醫(yī)院骨科（江蘇南通，226001）;;
  • 2 南通市第三人民醫(yī)院骨科;;
  • 3 蘇州大學(xué)附屬第二醫(yī)院骨科;

【摘 要】 目的 探討三重固定紐扣鋼板解剖重建喙鎖韌帶治療陳舊性Ⅲ度肩鎖關(guān)節(jié)脫位的手術(shù)方法及臨床療
效。 方法 2009 年1 月－ 2010 年6 月，對(duì)14 例陳舊性Ⅲ度肩鎖關(guān)節(jié)脫位行三重固定紐扣鋼板解剖重建喙鎖韌帶治療。
男10 例，女4 例；年齡26 ～ 52 歲，平均38.5 歲。致傷原因：交通事故傷7 例，摔傷5 例，砸傷2 例。左側(cè)9 例，右側(cè)5 例。
受傷至手術(shù)時(shí)間29 ～ 75 d，平均49 d。肩鎖關(guān)節(jié)有不同程度壓痛，關(guān)節(jié)主、被動(dòng)活動(dòng)明顯受限，X線片示肩鎖關(guān)節(jié)完全脫位。按Allman 分型標(biāo)準(zhǔn)，均為Ⅲ度完全性脫位。 結(jié)果 術(shù)后切口均Ⅰ期愈合，無血管、神經(jīng)損傷及感染等早期并發(fā)癥發(fā)生。
患者均獲隨訪，隨訪時(shí)間13 ～ 30 個(gè)月，平均18.3 個(gè)月。術(shù)后1 周1 例患者發(fā)生復(fù)位部分丟失，X 線片檢查見肩鎖關(guān)節(jié)半
脫位，未給予特殊處理，其余患者無再脫位或其他相關(guān)并發(fā)癥發(fā)生。末次隨訪時(shí)，根據(jù)美國肩肘外科協(xié)會(huì)（ASES）評(píng)分標(biāo)
準(zhǔn)，獲（90.8 ± 4.1）分，與術(shù)前的（65.3 ± 4.4）分比較，差異有統(tǒng)計(jì)學(xué)意義（t= —17.57，P=0.00）；Constant-Murley 評(píng)分為（91.7 ± 3.9）分，與術(shù)前的（71.5 ± 4.6）分比較，差異有統(tǒng)計(jì)學(xué)意義（t= —75.02，P=0.00）。簡(jiǎn)明肩關(guān)節(jié)功能測(cè)試問卷（SST）的肯定答案為7 ～ 12 個(gè)，平均9.7 個(gè)。 結(jié)論 三重固定紐扣鋼板解剖重建喙鎖韌帶可有效治療陳舊性Ⅲ度肩鎖關(guān)節(jié)脫位，早期療效滿意。

引用本文： 朱建煒 ,劉璠,張建華,董啟榕,李帥,侍德. 三重固定紐扣鋼板解剖重建陳舊性Ⅲ度肩鎖關(guān)節(jié)脫位. 中國修復(fù)重建外科雜志, 2012, 26(2): 201-204. doi: 復(fù)制

1. Richards RR, An KN, Bigliani L, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg, 1994, 3(6): 347-352.
2. Bearcroft PW, Blanchard TK, Dixon AK, et al. An assessment of the effectiveness of magnetic resonance imaging of the shoulder: literature review. Skeletal Radio, 2000, 29(12): 673-679.
3. Matsen F III. 肩關(guān)節(jié)外科學(xué)原理與實(shí)踐. 裴福興, 黃富國, 譯. 北京: 人民衛(wèi)生出版社, 2009: 3-4.
4. Bishop JY, Kaeding C. Treatment of the acute traumatic acromioclavivular separation. Sports Med Arthrosc, 2006, 14(4): 237-245.
5. Chernchujit B, Tischer T, Imhoff AB. Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results. Arch Orthop Trauma Surg, 2006, 126(9): 575-581.
6. Nissen CW, Chatterjee A. Type III acromioclavicular separation: results of a recent survey on its management. Am J Orthop (Belle Mead NJ), 2007, 36(2): 89-93.
7. Dimakopoulos P, Panagopoulos A, Syggelos SA, et al. Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med, 2006, 34(7): 1112-1119.
8. 陸葉, 陳云豐. 肩鎖關(guān)節(jié)脫位手術(shù)治療中修復(fù)重建方式及修復(fù)材料的臨床應(yīng)用研究與進(jìn)展. 中國組織工程研究與臨床康復(fù), 2009, 13(42): 8341-8345.
9. Sloan SM, Budoff JE, Hipp JA, et al. Coracoclavicular ligament reconstruction using the lateral half of the conjoined tendon. J Shoulder Elbow Surg, 2004, 13(2): 186-190.
10. 姜春巖, 朱以明, 王滿宜, 等. 聯(lián)合腱外側(cè)半肌腱反轉(zhuǎn)移位重建喙鎖韌帶治療肩鎖關(guān)節(jié)脫位. 中華創(chuàng)傷骨科雜志, 2005, 7(9): 803-807.
11. MacDonlad P, Sunner P, Dyck M. A follow-up of surgical treatment of type III AC dislocations. Proceeding of the closed ASES meeting, Houston, 2006.
12. Lee YS, Lau MJ, Tseng YC, et al. Comparison of the efficacy of hook plate versus tension band wire in the treatment of unstable fractures of the distal clavicle. Int Orthop, 2009, 33(5): 1401-1405.
13. Ejam S, Lind T, Falkenberg B. Surgical treatment of acute and chronic acromioclavicular dislocation Tossy type III and V using the hook plate. Acta Orthop Belg, 2008, 74(4): 441-445.
14. Struhl S. Double endobutton technique for repair of complete acromioclavicular joint dislocations. Tech Shoulder Elbow Surg, 2007, 8(4): 175-179.
15. 胡敏, 唐浩然, 劉慶, 等. Endobutton 帶袢鋼板內(nèi)固定治療Rockwood Ⅲ型肩鎖關(guān)節(jié)脫位. 中國骨與關(guān)節(jié)損傷雜志, 2010, 25(10): 900-901.
16. Tomlinson DP, Altchek DW, Davila J, et al. A modified technique of arthroscopically assisted AC joint reconstruction and preliminary results. Clin Orthop Relat Res, 2008, 466(3): 639-645.
17. Wellmann M, Zantop T, Petersen W. Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for treatment of total acromioclavicular joint dislocation. Arthroscopy, 2007, 23(10): 1132. e1-5.
18. Lim YW. Triple endobuttton technique in acromioclavicular joint reduction and reconstruction. Ann Acad Med Singapore, 2008, 37(4): 294-299.
  1. 1. Richards RR, An KN, Bigliani L, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg, 1994, 3(6): 347-352.
  2. 2. Bearcroft PW, Blanchard TK, Dixon AK, et al. An assessment of the effectiveness of magnetic resonance imaging of the shoulder: literature review. Skeletal Radio, 2000, 29(12): 673-679.
  3. 3. Matsen F III. 肩關(guān)節(jié)外科學(xué)原理與實(shí)踐. 裴福興, 黃富國, 譯. 北京: 人民衛(wèi)生出版社, 2009: 3-4.
  4. 4. Bishop JY, Kaeding C. Treatment of the acute traumatic acromioclavivular separation. Sports Med Arthrosc, 2006, 14(4): 237-245.
  5. 5. Chernchujit B, Tischer T, Imhoff AB. Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results. Arch Orthop Trauma Surg, 2006, 126(9): 575-581.
  6. 6. Nissen CW, Chatterjee A. Type III acromioclavicular separation: results of a recent survey on its management. Am J Orthop (Belle Mead NJ), 2007, 36(2): 89-93.
  7. 7. Dimakopoulos P, Panagopoulos A, Syggelos SA, et al. Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med, 2006, 34(7): 1112-1119.
  8. 8. 陸葉, 陳云豐. 肩鎖關(guān)節(jié)脫位手術(shù)治療中修復(fù)重建方式及修復(fù)材料的臨床應(yīng)用研究與進(jìn)展. 中國組織工程研究與臨床康復(fù), 2009, 13(42): 8341-8345.
  9. 9. Sloan SM, Budoff JE, Hipp JA, et al. Coracoclavicular ligament reconstruction using the lateral half of the conjoined tendon. J Shoulder Elbow Surg, 2004, 13(2): 186-190.
  10. 10. 姜春巖, 朱以明, 王滿宜, 等. 聯(lián)合腱外側(cè)半肌腱反轉(zhuǎn)移位重建喙鎖韌帶治療肩鎖關(guān)節(jié)脫位. 中華創(chuàng)傷骨科雜志, 2005, 7(9): 803-807.
  11. 11. MacDonlad P, Sunner P, Dyck M. A follow-up of surgical treatment of type III AC dislocations. Proceeding of the closed ASES meeting, Houston, 2006.
  12. 12. Lee YS, Lau MJ, Tseng YC, et al. Comparison of the efficacy of hook plate versus tension band wire in the treatment of unstable fractures of the distal clavicle. Int Orthop, 2009, 33(5): 1401-1405.
  13. 13. Ejam S, Lind T, Falkenberg B. Surgical treatment of acute and chronic acromioclavicular dislocation Tossy type III and V using the hook plate. Acta Orthop Belg, 2008, 74(4): 441-445.
  14. 14. Struhl S. Double endobutton technique for repair of complete acromioclavicular joint dislocations. Tech Shoulder Elbow Surg, 2007, 8(4): 175-179.
  15. 15. 胡敏, 唐浩然, 劉慶, 等. Endobutton 帶袢鋼板內(nèi)固定治療Rockwood Ⅲ型肩鎖關(guān)節(jié)脫位. 中國骨與關(guān)節(jié)損傷雜志, 2010, 25(10): 900-901.
  16. 16. Tomlinson DP, Altchek DW, Davila J, et al. A modified technique of arthroscopically assisted AC joint reconstruction and preliminary results. Clin Orthop Relat Res, 2008, 466(3): 639-645.
  17. 17. Wellmann M, Zantop T, Petersen W. Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for treatment of total acromioclavicular joint dislocation. Arthroscopy, 2007, 23(10): 1132. e1-5.
  18. 18. Lim YW. Triple endobuttton technique in acromioclavicular joint reduction and reconstruction. Ann Acad Med Singapore, 2008, 37(4): 294-299.