小切口可调节带袢钛板固定肩锁脱位

Adjustable suture- plate loop for open reduction and internal fixation of acromioclavicular dislocation through mini inci⁃ sions

摘要:

［目的］介绍开放小切口下应用可调节袢-板治疗急性肩锁关节脱位的的手术技术和初步临床效果。［方法］对 15 例 Tossy III 型的急性肩锁关节脱位损伤患者行上述手术方法治疗。于喙突处偏外侧体表作纵行小切口，锁骨远端前侧作行小切口，显露喙突和锁骨，定位器定位于锁骨外段和喙突基底，打入导针，钻直径 4.5 mm 的骨道，引入可调节带袢钛板联合四叶草型钛板，拉紧线袢复位固定肩锁关节。［结果］所有患者均顺利完成手术，手术时间平均 （36.5±15.2）min，切口总长度平均 （4.3±0.2）cm，所有患者切口均一期愈合。随访（12.7±3.3）个月。末次随访时，VAS 评分、肩关节 Constant 评分、肩关节外展、 外旋、内旋、前屈均较术前显著改善（P<0.05）。［结论］ 可调节带袢钛板联合四叶草型钛板治疗急性肩锁关节脱位具有医源性创伤小、手术时间短、无需肩关节镜技术基础的直视下手术操作等优点。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcome of adjustable suture-plate loop for open re- duction and internal fixation of acute acromioclavicular dislocation through mini incisions. [Methods] A total of 15 patients received aboves- aid surgical treatment for Tossy type III acute acromioclavicular dislocation. A small longitudinal incision was made on the lateral body sur- face of the coracoid process, while a small transvers incision was made on the anterior side of the distal clavicle to expose the coracoid pro- cess and clavicle. As the locator was positioned on the distal clavicle and the base of coracoid process, a guide needle was inserted, and bone tunnels 4.5mm in diameter was drilled. An adjustable suture- plate loop with a four- leaf clover- shaped titanium plate was introduced through the tunnels, and then the loop was tightened to reduce and fix the acromioclavicular joint. [Results] All patients had operation per- formed successfully with operation time of (36.5±15.2) min and total incision length of (4.3±0.2) cm, and got incisions healed well. At the lat- est follow-up lasted for (12.7±3.3) months, the VAS score and Constant-Murley score, as well as abduction, external rotation, internal rota- tion, and forward flexion range of motion (ROM) of the shoulder significantly improved compared with those preoperatively (P＜0.05). [Conclusion] This adjustable suture-plate loop for open reduction and internal fixation of acute acromioclavicular dislocation through mini inci- sions has the advantages of less iatrogenic trauma, shorter operation time, and surgical operation under direct vision without needing the tech- nique basis of shoulder arthroscopy.