肩锁脱位蜂巢状钛板喙锁和肩锁韧带重建△（开放获取）

Simultaneous coracoclavicular and acromioclavicular ligament reconstruction with honeycomb-like titanium plates for ac⁃ romioclavicular dislocation

摘要:

[目的] 介绍“蜂巢”钛板肩锁和喙锁韧带重建治疗肩锁关节脱位的手术技术和初步临床效果。[方法] 2019 年 1 月—2021 年 1 月 20 例肩锁关节脱位患者接受上述手术治疗。自肩锁关节至喙突上方行 7 cm 横切口，显露喙突基底部和肩锁关节上表面骨面。分别在喙突、锁骨、肩峰上用克氏针建立骨隧道，通过引线将蜂巢钛板和超强缝线引入骨隧道后，复位肩锁关节，滑动结收紧缝线完成固定。[结果]患者均获得随访，随访时间平均（13.3±1.2）个月。与术前相比，末次随访时 VAS 评分 [(5.0±1.1), (1.5±0.5), P＜0.001]、Constant-Murley 评分 [(56.6±3.8), (89.6±3.6), P＜0.001] 和 ASES 评分 [(63.4±5.0), (90.5±3.8), P＜0.001] 均显著改善。影像方面，与术前相比，末次随访时喙锁间距 （coracoclavicular distance, CCD） [(23.6±3.5) mm, (10.2±1.4) mm, P＜ 0.001] 显著改善。[结论]“蜂巢”钛板肩锁和喙锁韧带重建治疗肩锁关节脱位，固定强度好，术后并发症发生率低，有利于肩关节功能恢复。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of honeycomb-like titanium plates used for concurrent reconstruction of acromioclavicular ligament and coracoclavicular ligament for acromioclavicular dislocation. [Methods] From January 2019 to January 2021, 20 patients received abovesaid surgical procedures for acromioclavicular dislocation. A 7cm transverse incision was made from acromioclavicular joint to the top of coracoid process to reveal the base of coracoid process and the upper surface of acromioclavicular joint. Bone tunnels were established on coracoid process, clavicle and acromion with Kirschner wires, respectively. After the honeycomb titanium plates and super-strong suture were introduced into the bone tunnel through the lead wire, the acromioclavicular joint was reduced, and fixed by tightening the sliding suture knots. [Results] All patients had operation performed smoothly and were followed up for an average of (13.3±1.2) months. Compared with those before surgery, the VAS scores [(5.0±1.1), (1.5±0.5), P＜0.001], the Constant-Murley score [(56.6±3.8), (89.6±3.6), P＜0.001] and ASES score [(63.4±5.0), (90.5±3.8), P＜0.001] were significantly improved at the last followup. In terms of imaging, the coracoclavicular distance (CCD) [(23.6±3.5) mm, (10.2±1.4) mm, P＜0.001] was significantly improved at the last follow-up compared with that preoperatively. [Conclusion] The honeycomb-like titanium plates used for concurrent reconstruction of acromioclavicular ligament and coracoclavicular ligament for acromioclavicular dislocation have good fixation strength and low incidence of postoperative complications, are conducive to the functional recovery of the shoulder