Objective :To study the clinical effects of acromiocoracoid ligament transfer to repair coracoclavicular ligament and acromioclavicular ligament in the treatment of acromioclavicular joint dislocation of type Tossy ID in young patients. Methods : From January 2005 to January 2007,52 patients with acromioclavicular joint dislocation of type Tossy HI were divided into therapeutic group I (32 cases) and therapeutic group D (22 cases). There were 17 males and 13 females with an average age of 31.0 years (ranged, 19 to 40 years) in group I ; as well as 12 males and 10 females with an average age of 33.6 years (ranged, 20 to 42 years) in group II. All the patients were fresh injury and the acromioclavicular joint dislocations were type Tossy M according to X-ray findings. The duration from damage to the operation time ranged from 2 to 17 days (averaged ,7.6 days). All the patients had normal shoulder function before injury and were treated with clavicular hook plate implantation. The patients in group II were treated with normal desmorrhaphy method,and the patients in group I were treated with acromiocoracoid ligament transfer to repair coracoclavicular ligament and acromioclavicular ligament. Steel plate was taken out at about 4 to 6 months after clavicular hook plate implantation. The results were evaluated according to Karlsson' s standards. Results: All the incisions healed without infection. The therapeutic effects of 52 patients were evaluated at the 6th month after internal fixation was taken out. Twenty-four patients in group 1 got an excellent results and 6 good; 17 patients in group D got an excellent results and 5 good. There was no significant difference between the two groups. Twenty-six patients in group I and 19 patients in group D had long-term follow-up,and the duration ranged from 3 to 5 years (averaged,4.5 years ). Twenty patients in group I got an excellent results and 6 good;9 patients in group D got an excellent results,7 good and 3 bad. Three patients in group II had recurrence of acromioclavicular joint dislocation. The long-term therapeutic effects of group I was better than that of group II. Conclusion : After clavicular hook plate implantation in treating type Tossy U dislocation of the acromioclavicular joint in young patients , it was necessary to use acromiocoracoid ligament transfer to repair coracoclavicular ligament and acromioclavicular ligament , which can improve the stability of acromioclavicular joint to prevent dislocation recurrence.%目的:探讨喙肩韧带转移修补喙锁韧带及肩锁韧带治疗青壮年新鲜TossyⅢ型肩锁关节脱位的临床疗效.方法:2005年1月至2007年1月,将52例TossyⅢ型肩锁关节脱位患者分成2组:Ⅰ组30例,男17例,女13例,年龄19～40岁,平均31.0岁；Ⅱ组22例,男12例,女10例,年龄20～42岁,平均33.6岁.所有损伤为新鲜损伤,X线表现为TossyⅢ型肩锁关节脱位,损伤至手术时间2～17d,平均7.6 d.所有患者受伤前肩关节活动正常.2组均采用锁骨钩钢板固定,Ⅰ组行喙肩韧带转移以修补喙锁韧带及肩锁韧带,Ⅱ组行常规韧带缝合术.治疗后按Karlsson标准评定疗效.结果:2组患者切口均Ⅰ期愈合.取出内固定后6个月随访,Ⅰ组优24例,良6例；Ⅱ组优17例,良5例.2组疗效差异无统计学意义.Ⅰ组26例及Ⅱ组19例于取出内固定后随防3～5年,平均4.5年,Ⅱ组3例取出内固定后肩锁关节脱位复发.Ⅰ组优20例,良6例；Ⅱ组优9例,良7例,差3例.Ⅰ组疗效优于Ⅱ组.结论:青壮年新鲜TossyⅢ型肩锁关节脱位采用锁骨钩钢板固定后,喙肩韧带转移修补喙锁韧带及肩锁韧带可以提高修复后肩锁关节稳定性,预防脱位再复发.
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