Jiang Chunyan, Wang Manyi, Rong Guowei
Shoulder Service, Department of Orthopedics, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, No. 31 Xinjiekoudongie, 100035 Beijing, People's Republic of China.
J Bone Joint Surg Am. 2007 Nov;89(11):2408-12. doi: 10.2106/JBJS.F.01586.
We report an alternative to the modified Weaver-Dunn technique that can achieve stable coracoclavicular reconstruction while avoiding sacrifice of the coracoacromial arch. The purpose of this study was to retrospectively analyze the functional outcomes and radiographic features of patients treated with coracoclavicular ligament reconstruction with use of a proximally based conjoined tendon transfer.
The cases of thirty-eight patients with type-IV, type-V, and selected type-III acromioclavicular dislocations according to the Rockwood classification system, who were followed for an average follow-up of 38.7 months, were evaluated retrospectively. Transfer of the lateral half of the conjoined tendon to the distal aspect of the clavicle in a proximally based fashion, with additional coracoclavicular fixation, was performed in all patients. At the latest follow-up evaluation, radiographic analysis and the scores on the American Shoulder and Elbow Surgeons, Constant and Murley, and Simple Shoulder Test questionnaires were used to provide a final evaluation of shoulder function. The ability to return to work and the ability to return to sports were also recorded.
At the time of final follow-up, the mean American Shoulder and Elbow Surgeons score was 91.4, with a mean pain score on the visual analog scale of 1.8, mean forward flexion of 148.2 degrees , and mean external rotation of 38.0 degrees . The mean Constant and Murley score was 90.6. The new number of positive answers on the Simple Shoulder Test was 10.9. The overall rate of satisfaction (an excellent or good result) was 89% (thirty-four patients). Thirty-five (92%) of the thirty-eight patients returned to their previous work, and thirty-two (84%) returned to their preinjury level of sports.
The proximally based conjoined tendon transfer is a reliable treatment for a high-grade acromioclavicular dislocation. The lateral half of the conjoined tendon is a safe graft source with ample length, and this technique avoids sacrifice of the coracoacromial ligament.
我们报告一种改良韦弗-邓恩技术的替代方法，该方法可实现稳定的喙锁重建，同时避免牺牲喙肩弓。本研究的目的是回顾性分析采用近端联合肌腱转位进行喙锁韧带重建治疗的患者的功能结果和影像学特征。
回顾性评估38例根据罗克伍德分类系统为IV型、V型以及部分III型肩锁关节脱位的患者，平均随访38.7个月。所有患者均采用近端联合肌腱外侧半以近端为基底转位至锁骨远端，并附加喙锁固定。在最近的随访评估中，通过影像学分析以及美国肩肘外科医师学会、康斯坦特和默利、简易肩关节测试问卷的评分对肩部功能进行最终评估。还记录了患者恢复工作和恢复运动的能力。
在最终随访时，美国肩肘外科医师学会平均评分为91.4分，视觉模拟量表平均疼痛评分为1.8分，平均前屈为148.2度，平均外旋为38.0度。康斯坦特和默利平均评分为90.6分。简易肩关节测试新的阳性回答数为10.9个。总体满意度（优秀或良好结果）率为89%（34例患者）。38例患者中有35例（92%）恢复了之前的工作，32例（84%）恢复到受伤前的运动水平。
近端联合肌腱转位是治疗重度肩锁关节脱位的可靠方法。联合肌腱外侧半是一种安全的移植物来源，长度充足，该技术避免了喙肩韧带的牺牲。
