联合腱或髂胫束重建喙锁韧带钩钢板固定治疗 肩锁关节脱位的

目的探讨采用联合腱外侧半肌腱逆转和髂胫束重建喙锁韧带附加钩钢板固定治疗肩锁关节脱位的疗效，对比分析两者的优劣性，为临床治疗提供依据。方法 自2005年6月至2012年6月，将Rookwood Ⅲ型以上肩锁关节脱位符合纳入排除标准的74例患者随机分为联合腱外侧半肌腱重建组（36例）和髂胫束筋膜条重建组（38例），重建喙锁韧带后皆使用肩锁钩钢板固定。定期随访患者，钩钢板取出后测量肩锁间间距和喙锁间间距。应用Karlsson评分和Constant-Murley评分对疗效进行评估。等级资料应用X2检验，计量资料采用两样本t检验分析。结果 74例患者全部获得随访，随访时间16-24个月，平均20个月。联合腱外侧半肌腱重建组36例，髂胫束筋膜条重建组38例，两组患者在年龄、性别、受伤侧别及脱位分型方面具有可比性。两组患者在钩钢板取出后6个月内，肩锁间间距和喙锁间间距无统计学差异（P0.05），术后12个月联合腱外侧半肌腱重建组肩锁间间距和喙锁间间距明显大于髂胫束筋膜条重建组（t =2.313和2.114, P0.05, P0.05）。两组术后12个月的肩锁间间距和喙锁间间距均大于术后6个月（t=2.631和2.297，P0.05）。 Constant-Murley评分联合腱外侧半肌腱重建组平均85.15±10.21分低于髂胫束筋膜条重建组93.05±6.869分（t=2.965,P=0.006）。 Karlsson评分联合腱外侧半肌腱重建组功能优良率为75.00%，明显低于髂胫束筋膜条重建组94.74%（X2=8.111，P=0.044）。结论 髂胫束筋膜条重建喙锁韧带治疗Rookwood Ⅲ型以上肩锁关节脱位疗效优于联合腱外侧半肌腱重建喙锁韧带。钩钢板取出后，两者肩锁间间距和喙锁间间距都增大，联合腱外侧半肌腱髂胫束筋膜条重建增大的更为明显。宁夏医科大学总医院创伤骨科安维军

【关键词】 肩锁关节脱位；喙锁韧带；重建

【Abstract】 Objective To investigate the clinical outcomes of acromioclavicular joint (ACJ) dislocation treated with coracoclavicular ligament (CCL) reconstruction using lateral half of the conjoined tendon and tractusiliotibialis with hook plate fixation. Comparative study on their advantages and disadvantages in order to provide the materials for the clinic.Method Patients with Rockwood type III or severer ACJ dislocation were randomly divided into two groups from June 2005 to June 2012. They were treated with CCL reconstruction using lateral half of the conjoined tendon(conjoined tendon reconstruction group, 36 cases) and tractusiliotibialis (tractusiliotibialis reconstruction group, 38 cases)subsequently fixed with hook plates. Patients were followed up, and the AC distance and CC distance were measured on the postoperative X-ray films after hook plates were removed, and the outcomes were assessed according to Karlsson criteria and Constant-Murley shoulder score. Ranked date was analyzed with the use of X2 test and measurement date with twe sample t test.Result 74 patients were followed up,the time was 12-24 months, average 20 months. 36 cases of conjoined tendon reconstruction group and 38 cases of had no significant difference in age,genden,injured side and classification between two groups. No statistics difference with the AC distance and CC distance between two groups within 6 months （P0.05）after hook plates were removed. The AC distance and CC distance of conjoined tendon reconstruction group were larger than that of tractusiliotibialis reconstruction group（t=2.313，t =2.114, P0.05）within 12 months. The AC distance and CCdistance of 12 months were both lager than 6 months(t=2.631和2.297，P0.05). According to the Constant-Murley shoulder csore ,score was 85.15±10.21 of the conjoined tendon reconstruction group less than 93.05±6.869 of the tractusiliotibialis reconstruction group（t=2.965,P=0.006）。According to Karlsson Criteria, the excellent and good rate of the functional recovery was 75.00% in conjoined tendon reconstruction group, less than 94.74% in tractusiliotibialis reconstruction group（X2=8.111，P=0.044）。Conclusion The effects of treatment of Rookwood type Ⅲ acromioclavicular joint dislocation for reconstructing coracoclavicular ligament using tractusiliotibialis is better than using the conjoined tendon. The AC distance and CC distance of both increased after hook plates were removed, whith of conjoined tendon tractusiliotibialis reconstruction increased much obviously.

[key words] acromioclavicular joint dislocation; coracoclavicular ligament ; reconstruction