镜下喙突免钻孔喙锁韧带重建术

Arthroscopic reconstruction of coracoclavicular ligament without coracoid tunnel

摘要:

[目的] 介绍镜下喙突免钻孔喙锁韧带重建术的手术技术和初步临床效果。[方法] 2020 年 4 月—2021 年 9 月，对 18 例肩锁关节脱位（Rockwood Ⅲ~V）患者采用关节镜监视下喙突免钻孔喙锁韧带重建术进行治疗。首先于锁骨外侧占其全长 16%、25%位置处建立锁骨双隧道。利用引线将 TightRope 钢板的高强线绕过喙突基底部，并从锁骨双隧道穿出。内侧隧道放置纽扣板，外侧隧道放置可调板。然后收紧高强线使袢钢板与锁骨紧密贴合，逐渐复位肩锁关节，最后再次打结固定。[结果] 所有患者均顺利完成手术，无严重并发症，随访时间 5~22 个月。与术前相比，末次随访时肩关节 VAS、ASES 评分和 Constant 评分均显著改善（P＜0.05）。[结论]关节镜下喙突免钻孔喙锁韧带重建术治疗肩锁关节脱位能够取得良好临床疗效。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic reconstruction of coracocla- vicular ligament without coracoid tunnel. [Methods] From April 2020 to September 2021, a total of 18 patients received abovesaid surgical treatment for Rockwood III-V acromioclavicular dislocation. Two clavicular tunnel was established on the lateral clavicle at16% and 25% of its total length respectively, and the coracoid under surface was released arthroscopically. Subsequently, the Tightrope with highstrength sutures and two- end button plates were introduced through a clavicle tunnel, pass under the coracoid bottom, and then pass through the other clavicular tunnel by leading wire. As both end button plates were set on the superior surface of the clavicle, the sutures were pull equally to tighten the Tightrope gradually and reduce the acromioclavicular joint, finally, the sutures were tied and fastened. [Re- sults] All patients had surgical procedures performed successfully without serious complications, and were followed up for 5~22 months. The ASES, VAS and Constant scores significantly improved at the latest follow up compared with those before operation (P＜0.05). [Conclu- sion] Arthroscopic reconstruction of coracoclavicular ligament without coracoid tunnel does achieve satisfactory clinical outcomes for acro- mioclavicular joint dislocation.