喙锁韧带重建后骨隧道扩大对临床结果的影响△

Effect of bone tunnel enlargement on clinical outcome after coracoclavicular ligament anatomic reconstruction

摘要:

[目的] 探讨喙锁韧带解剖重建术后锁骨、喙突隧道扩大和复位丢失对临床结果的影响。[方法] 回顾性分析 2012 年 11 月—2021 年 12 月，本科采用喙锁韧带解剖重建治疗的 III~V 型肩锁关节的 30 例患者。采用 ASES、Constant-Murley 和 ULCA 评分评价临床效果，测量喙锁间距 (coracoclavicaular distance, CCD)、喙突隧道最大直径和锁骨隧道最大直径。采用 Pearson 相关分析临床评分与影像测量指标变化量的相关性。[结果]30 例患者均顺利完成手术，随访(13.5±4.5)个月。与术前相比，末次随访时，ASES、Constant-Murley 和 ULCA 评分均显著增加 (P＜0.05)。与术后 3 d 内的影像学相比，末次随访时喙突骨隧道及锁骨骨隧道最大直径显著增加 (P＜0.05)。CCD 显著增大 (P＜0.05)。末次随访时 ASES、Constant-Murley 和 UL- CA 评分与影像测量喙突骨隧道最大直径变化、锁骨骨隧道最大直径变化和 CCD 变化均无显著相关性 (P＞0.05)。末次随访时 CCD 变化与喙突骨隧道最大直径变化、锁骨骨隧道最大直径变化无显著相关性(P＞0.05)。喙突骨隧道最大直径变化与锁骨骨隧道最大直径变化呈显著正相关(P＜0.05)。[结论]采用喙锁韧带解剖重建治疗肩锁脱位术后锁骨和喙突隧道出现一定程度的扩大，但是隧道扩大与复位丢失之间没有相关性，隧道扩大对临床效果没有影响。

Abstract:

[Objective] To explore the effect of clavicular and coracoid bone tunnel enlargement and reduction loss on clinical out- comes after coracoclavicular ligament anatomical reconstruction. [Methods] A retrospective study was conducted on 30 patients who re- ceived coracoclavicular ligament anatomical reconstruction for Rockwood type III-V acromioclavicular dislocation in our department from November 2012 to December 2021. Clinical outcomes were evaluated by ASES, Constant-Murley and ULCA scores, whereas the coraco- clavicaular distance (CCD) , maximum diameter of coracoid bone tunnel and clavicular bone tunnel were measured radiographically. Pear- son or Spearman correlation analyses was used to search the correlation between clinical scores and changes of imaging measurement pa- rameters. [Results] All the 30 patients were successfully operated on, and followed up for (13.5±4.5) months on an average. At latest followup, the ASES, Constant-Murley and ULCA scores significantly increased compared with those preoperatively (P＜0.05) . However, the CCD and maximum diameter of coracoid and clavicular bone tunnel significantly increased at the latest follow-up compared with those within 3 days after operation (P＜0.05) . At latest follow-up, the ASES, Constant-Murley and ULCA scores proved not significantly correlated with the increments of CCD and the maximum diameter of coracoid and clavicular bone tunnels (P＞0.05) . Moreover, the increment of CCD was not correlated with those of the maximum diameter of coracoid and clavicle bone tunnels (P＞0.05) . The increment of maximum diameter of coracoid bone tunnel was positively correlated with that of the maximum diameter of clavicle bone tunnel (P＜0.05) . [Conclusion] The clavi- cle and coracoid bone tunnels does be enlarged in some extent after coracoclavicular ligament anatomical reconstruction for Rockwood type III-V acromioclavicular dislocation. However, the bone tunnel enlargement is not proved related to reduction loss, and has no effect on the clinical outcome.