• 1 南通大學附屬醫(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度肩鎖關節(jié)脫位的手術方法及臨床療
效。 方法 2009 年1 月－ 2010 年6 月，對14 例陳舊性Ⅲ度肩鎖關節(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9 例，右側5 例。
受傷至手術時間29 ～ 75 d，平均49 d。肩鎖關節(jié)有不同程度壓痛，關節(jié)主、被動活動明顯受限，X線片示肩鎖關節(jié)完全脫位。按Allman 分型標準，均為Ⅲ度完全性脫位。 結果 術后切口均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，隨訪時間13 ～ 30 個月，平均18.3 個月。術后1 周1 例患者發(fā)生復位部分丟失，X 線片檢查見肩鎖關節(jié)半
脫位，未給予特殊處理，其余患者無再脫位或其他相關并發(fā)癥發(fā)生。末次隨訪時，根據(jù)美國肩肘外科協(xié)會（ASES）評分標
準，獲（90.8 ± 4.1）分，與術前的（65.3 ± 4.4）分比較，差異有統(tǒng)計學意義（t= —17.57，P=0.00）；Constant-Murley 評分為（91.7 ± 3.9）分，與術前的（71.5 ± 4.6）分比較，差異有統(tǒng)計學意義（t= —75.02，P=0.00）。簡明肩關節(jié)功能測試問卷（SST）的肯定答案為7 ～ 12 個，平均9.7 個。 結論 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度肩鎖關節(jié)脫位. 中國修復重建外科雜志, 2012, 26(2): 201-204. doi: 復制

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. 肩關節(jié)外科學原理與實踐. 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. 肩鎖關節(jié)脫位手術治療中修復重建方式及修復材料的臨床應用研究與進展. 中國組織工程研究與臨床康復, 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)合腱外側半肌腱反轉移位重建喙鎖韌帶治療肩鎖關節(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型肩鎖關節(jié)脫位. 中國骨與關節(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. 肩關節(jié)外科學原理與實踐. 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. 肩鎖關節(jié)脫位手術治療中修復重建方式及修復材料的臨床應用研究與進展. 中國組織工程研究與臨床康復, 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)合腱外側半肌腱反轉移位重建喙鎖韌帶治療肩鎖關節(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型肩鎖關節(jié)脫位. 中國骨與關節(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.