Terra Bernardo Barcellos, Rodrigues Leandro Marano, Pádua David Victoria Hoffmann, Martins Marcelo Giovanini, Teixeira João Carlos de Medeiros, De Nadai Anderson
Hospital Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil.
Rev Bras Ortop. 2015 Jul 10;50(4):472-7. doi: 10.1016/j.rboe.2015.06.019. eCollection 2015 Jul-Aug.
Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the "figure of eight" technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified "figure of eight" and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our study presented a case of chronic anterior dislocation of the sternoclavicular joint that was successfully treated by using a modification of the "figure of eight" reconstruction technique. This technique was shown to be safe and effective, and it allowed the patient to fully return to his sports activities.
胸锁关节脱位占肩胛带所有脱位的比例不到5%。大多数胸锁关节前脱位病例没有症状。然而，一些患者可能会出现慢性前不稳定并持续有症状，这些情况下需要进行手术治疗。文献中关于创伤性前不稳定病例使用掌长肌腱进行重建的报道较少。尽管这些损伤罕见，但为避免未来并发症，仍需快速诊断和有效治疗。本报告的目的是报告一例摩托车越野赛选手，他出现了胸锁关节慢性创伤性前不稳定，并接受了自体掌长肌腱的手术重建。患者为一名33岁男性，有在摩托车越野比赛中一次动作失误摔倒后胸锁关节前脱位的病史。最初采取保守治疗，包括使用功能性吊带治疗症状3周，以及进行3个月的物理治疗康复。我们根据斯宾塞和库恩的研究选择了一种改良的“8字”技术。在胸锁关节水平做一个约10厘米的纵向切口。取自同侧掌长肌腱的移植物以改良“8字”形式穿过孔道，其两端缝合在一起。患者使用美式吊带固定4周。随访6个月后，当需要胸锁关节活动时，患者不再有疼痛或不稳定症状。胸锁关节仍有轻微不适和轻度突出，但不影响患者活动。因此，患者术后6个月能够重返赛场。我们的研究展示了一例胸锁关节慢性前脱位病例，通过改良的“8字”重建技术成功治疗。该技术被证明是安全有效的，使患者能够完全恢复体育活动。
