肩鎖關(guān)節(jié)脫位治療

1、關(guān)節(jié)鏡下自體腘繩肌腱移植治療肩鎖關(guān)節(jié)脫位,骨一科 董海濤,,郭某，男，49歲，外傷致左肩關(guān)節(jié)疼痛不適3小時入院,診斷：肩鎖關(guān)節(jié)脫位，III度治療：1、鎖骨鉤鋼板？ 2、其他？,經(jīng)過討論，我們的治療方案定為： ——————重建喙鎖韌帶+修復(fù)肩鎖關(guān)節(jié)囊,手術(shù)方法--腘繩肌腱切取,膝關(guān)節(jié)屈曲90度，于脛骨結(jié)節(jié)內(nèi)側(cè)作斜切口3CM長，分離半腱肌和股薄肌腱，在鵝足止點處切斷

2、，套入取腱器，沿肌腱的縱軸平行推進，取下長度約20－30CM長的肌腱，刮除腱端的肌肉組織。,gracilis,semitendinosus,G,ST,,,,手術(shù)過程,一,二,三,四,六,五,八,七,九,十,術(shù)后X線片,問題,1、鎖骨骨道所選位置是否合適？,2、所選固定方式是否牢靠？,（斜方韌帶）,（錐狀韌帶）,解剖,Rockwood 分型,治療：1、Ⅰ型、Ⅱ型保守治療，Ⅲ型治療存在爭議。2、Ⅳ Ⅴ Ⅵ型損傷首選手術(shù)治療。指出重建

3、正常韌帶的解剖結(jié)構(gòu)比改變骨的正常結(jié)構(gòu)更可以穩(wěn)定關(guān)節(jié)。,Ashjian RZ, Southam JD, Clevenger T, Bachus KN. Biomechanical evaluation of graft fixation techniques for acromioclavicular joint reconstructions using coracoclavicular tendon grafts. J Shoulde

4、r Elbow Surg 2012;21:1573-1579.,,,Arthroscopy Techniques, Vol 6, No 3 (June), 2017: pp e641-e648,,The left shoulder is being operated on, with the patientin the beach chair position. The ipsilateral leg is also drapedf

5、or graft harvest. The table is kept as low as possible, and thehead is stabilized properly with supports.,A gauze piece is shuttled using thisloop, which helps to dilate passage for the graft. After the passage is cr-

6、eated, the graft is shuttled using this gauze piece.,We removed a 6-mm bone piece of the lateral end of the clavicle and found it to be a safe margin to avoid bone contact.,,,,術(shù)前,術(shù)后,總結(jié),優(yōu)點：1. 此法為解剖學(xué)重建。2.使用植入物較小。3.關(guān)節(jié)