Objective: To investigate the effectiveness of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique in the treatment of acute acromioclavicular joint dislocation.
Methods: A clinical data of 28 patients with acute acromioclavicular joint dislocation who met the selection criteria and admitted between June 2018 and December 2021 was retrospectively analyzed. There were 18 males and 10 females, with an average age of 47.7 years (range, 22-72 years). The causes of injury included falling (13 cases) and traffic accidents (15 cases). The acromioclavicular joint dislocation was rated as Rockwood type Ⅲ in 7 cases, type Ⅳ in 16 cases, and type Ⅴ in 5 cases. The time from injury to operation was 4-13 days, with an average of 9.5 days. The acromioclavicular joint dislocation was reconstructed with TightRope system and high-strength wire by Locking-Loop methods during operation. The operation time and complications were recorded. Visual analogue scale (VAS) score, Constant-Murley score, and active range of motion of shoulder (forward flexion and upward lift, abduction and upward lift, and external rotation) were recorded before operation and at 12 months after operation to evaluate the functional recovery of shoulder. The loss of acromioclavicular joint reduction was assessed by comparing the coracoclavicular distance (CCD) based on the anteroposterior X-ray films at 3 days and 12 months after operation.
Results: The operation time was 58-100 minutes (median, 85 minutes). All incisions healed by first intention. All patients were followed up 12 months. During follow-up, 2 patients developed shoulder adhesion, which recovered after rehabilitation exercise. At 12 months after operation, the VAS score was significantly lower, the Constant-Murley score was significantly higher, and the range of motion of the shoulder joint (forward flexion and upward lift, abduction and upward lift, and external rotation) significantly increased when compared with preoperative ones ( P<0.05). X-ray films showed that the CCD was 8.4 (7.3, 9.4) and 9.2 (8.1, 10.1) mm at 3 days and 12 months after operation, respectively, with a significant difference ( Z=-4.665, P<0.001). During follow-up, there was no complication such as infection, titanium plate entrapment, fracture, internal fixation failure, or redislocation.
Conclusion: The treatment of acute acromioclavicular joint dislocation with TightRope system combined with Locking-Loop biplane anatomical reconstruction has the advantages of small incision, joint reduction under direct vision, high fixation strength, and low incidence of postoperative complications, which can effectively relieve the pain of patients' shoulder joint and facilitate the recovery of shoulder joint function.
目的: 探讨TightRope联合Locking-Loop双平面解剖重建技术治疗急性肩锁关节脱位的疗效。.
方法: 回顾性分析2018年6月—2021年12月收治且符合选择标准的28例急性肩锁关节脱位患者临床资料。男18例，女10例；年龄22～72岁，平均47.7岁。致伤原因：摔伤13例，交通事故伤15例。肩锁关节脱位Rockwood Ⅲ型7 例，Ⅳ型16例，Ⅴ型 5 例。 受伤至手术时间4～13 d，平均9.5 d。术中使用TightRope滑动锁扣钛板系统联合TigerTape线带Locking-Loop双平面解剖重建肩锁关节脱位。记录手术时间及并发症发生情况，比较术前及术后12个月肩关节疼痛视觉模拟评分（VAS）、肩关节功能Constant-Murley评分以及肩关节主动前屈上举、外展上举、外旋活动度，评价肩关节疼痛及功能恢复情况；比较术后3 d及12个月基于肩关节正位X线片测量的喙锁间距离（coracoclavicular distance，CCD），评估肩锁关节复位丢失情况。.
结果: 手术时间58～100 min，中位时间85 min。术后切口均Ⅰ期愈合。所有患者均获随访12个月。随访期间2例患者出现肩关节粘连，经康复锻炼后功能恢复。与术前相比，术后12个月VAS 评分降低，Constant-Murley评分提高，肩关节主动前屈上举、外展上举、外旋活动度增大，差异均有统计学意义（ P<0.05）。X线片复查示术后3 d及12个月CCD分别为8.4（7.3，9.4）、9.2（8.1，10.1）mm，差异有统计学意义（ Z=−4.665， P<0.001）。随访期间均无感染、钛板下陷、骨折、内固定失效及再脱位等并发症发生。.
结论: TightRope联合Locking-Loop双平面解剖重建技术治疗急性肩锁关节脱位，具有切口小、能在开放直视下复位关节、固定强度高、术后并发症发生率低等优势，可有效缓解患者肩关节疼痛，有利于肩关节功能恢复。.
Keywords: Acromioclavicular joint dislocation; anatomical reconstruction; biplane.