Lafosse Thibault, Fortané Thibaut, Lafosse Laurent
Hand, Upper Limb, Brachial Plexus, and Microsurgery Unit (PBMA), Alps Surgery Institute (ASI) Clinique Générale d'Annecy, Annecy, France.
Arthrosc Tech. 2020 Sep 25;9(10):e1485-e1494. doi: 10.1016/j.eats.2020.06.011. eCollection 2020 Oct.
Acute acromioclavicular (AC) joint dislocations are common and difficult to manage. The physiopathologic pattern begins with the rupture of the AC ligaments, then the coracoclavicular (CC) ligaments, and with an invasion of the clavicle through the deltotrapezial fascia. Therefore, we tend to perform a true suture of the CC ligaments, along with a release of the AC ligaments from the joint. We thus propose an all-endoscopic CC ligament suture and AC joint release. It starts with glenohumeral exploration enabling a repair of concomitant lesions when necessary. Dissection of the coracoid process is made, along with the lateral border of the conjoint tendon, medially the pectoralis minor tenotomy, and plexus brachial exposition and protection. Superiorly the CC ligaments are tagged and exposed. A major difference with others procedure then arises. We dissect the inferior and superior surfaces of the clavicle and the AC joint, although we maintain the continuity between the deltotrapezoid fascia and the AC ligaments. The AC dislocation is reduced under endoscopic control performing a true suture of the CC ligaments by the mean of 2 suture tapes and dog bones. After surgery, a shoulder brace is used for 6 weeks. Physiotherapy then begins.
急性肩锁关节脱位很常见且治疗困难。其病理生理过程始于肩锁韧带断裂，接着是喙锁韧带断裂，锁骨通过三角肌斜方肌筋膜侵入。因此，我们倾向于对喙锁韧带进行真正的缝合，并从关节处松解肩锁韧带。我们在此提出一种全内镜下喙锁韧带缝合及肩锁关节松解术。手术首先进行肩关节探查，必要时可修复合并损伤。对喙突进行解剖，同时显露联合肌腱的外侧缘，在内侧切断胸小肌肌腱，并显露和保护臂丛神经。在上方标记并显露喙锁韧带。与其他手术的一个主要区别随即出现。我们解剖锁骨和肩锁关节的上、下表面，尽管我们保持三角肌斜方肌筋膜与肩锁韧带之间的连续性。在内镜控制下复位肩锁关节脱位，通过两根缝合带和犬骨对喙锁韧带进行真正的缝合。术后使用肩部支具6周。然后开始物理治疗。
