目的 探討採用聯合腱外側半肌腱逆轉和髂脛束重建喙鎖韌帶附加鉤鋼板固定治療肩鎖關節脫位的療效，對比分析兩者的優劣性，為臨床治療提供依據。方法 自2005年6月至2012年6月，將Rookwood Ⅲ型以上肩鎖關節脫位符合納入排除標準的74例患者隨機分為聯合腱外側半肌腱重建組（36例）和髂脛束筋膜條重建組（38例），重建喙鎖韌帶後皆使用肩鎖鉤鋼板固定。定期隨訪患者，鉤鋼板取出後測量肩鎖間間距和喙鎖間間距。應用Karlsson評分和Constant-Murley評分對療效進行評估。等級資料應用X2檢驗，計量資料採用兩樣本t檢驗分析。結果 74例患者全部獲得隨訪，隨訪時間16-24個月，平均20個月。聯合腱外側半肌腱重建組36例，髂脛束筋膜條重建組38例，兩組患者在年齡、性別、受傷側別及脫位分型方面具有可比性。兩組患者在鉤鋼板取出後6個月內，肩鎖間間距和喙鎖間間距無統計學差異（P>0.05），術後12個月聯合腱外側半肌腱重建組肩鎖間間距和喙鎖間間距明顯大於髂脛束筋膜條重建組（t =2.313和2.114, P<0.05, P<0.05）。兩組術後12個月的肩鎖間間距和喙鎖間間距均大於術後6個月（t=2.631和2.297，P<0.05）。 Constant-Murley評分聯合腱外側半肌腱重建組平均85.15±10.21分低於髂脛束筋膜條重建組93.05±6.869分（t=2.965,P=0.006）。 Karlsson評分聯合腱外側半肌腱重建組功能優良率為75.00%，明顯低於髂脛束筋膜條重建組94.74%（X2=8.111，P=0.044）。結論
髂脛束筋膜條重建喙鎖韌帶治療Rookwood Ⅲ型以上肩鎖關節脫位療效優於聯合腱外側半肌腱重建喙鎖韌帶。鉤鋼板取出後，兩者肩鎖間間距和喙鎖間間距都增大，聯合腱外側半肌腱髂脛束筋膜條重建增大的更為明顯。寧夏醫科大學總醫院創傷骨科安維軍
【關鍵詞】 肩鎖關節脫位；喙鎖韌帶；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 （P>0.05）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, P<0.05）within 12 months. The AC distance and CCdistance of 12 months were both lager than 6 months(t=2.631和2.297，P<0.05). 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
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