关节镜下无喙突骨隧道悬吊式固定治疗急性肩锁关节脱位

doi:10.3877/cma.j.issn.1674-134X.2026.01.013

目的

探讨关节镜下无喙突骨隧道悬吊固定技术治疗急性肩锁关节脱位（ACJD）的临床疗效。

方法

回顾2022年01月至2024年12月在南京医科大学附属江宁医院接受关节镜下无喙突骨隧道悬吊固定技术治疗的ACJD患者的临床资料。收集包括年龄、性别、Rockwood分型、手术时间、术前及术后第1天视觉疼痛VAS评分、术前及术后6个月Constant-Murley肩关节评分，以及术前、术后1 d、术后1个月及6个月测量X线片上喙锁间隙大小。分别采用配对非参数检验、配对t检验、单因素重复测量方差分析比较术前和术后VAS评分、肩关节评分以及喙锁间隙变化。

结果

共纳入ACJD患者21例，均采用关节镜下无喙突骨隧道悬吊固定技术治疗。其中，男性11例，女性10例，中位手术年龄39岁，损伤至手术日平均（2.8±1.0）d，平均手术时长为（118±11）min。手术后VAS评分显著下降（Z=-230.0，P<0.001）。手术后Constant-Murley评分也显著上升（t=30.90，P<0.001）。术前、术后1 d、术后1个月及6个月的喙锁间隙分别为（24.0±4.1）mm，（5.2±1.0）mm，（5.6±1.1）mm以及（5.7±1.1）mm。术前与术后的喙锁间隙变化差异有统计学意义（校正后F=467.10，P<0.001）；术后1 d、术后1个月及6个月的喙锁间隙显著小于术前值（均为P<0.001），而术后1 d，术后1个月以及6个月的喙锁间隙之间差异无统计学意义（均为P>0.05）。

结论

关节镜下无喙突骨隧道悬吊固定技术治疗ACJD能够改善肩关节疼痛，维持肩关节功能，临床疗效满意。

关键词: 肩锁关节, 关节脱位, 关节镜检查, 喙突

Objective

To investigate the clinical effect of a novel arthroscopic suspension fixation without coracoid bone tunnel in the treatment of acute acromioclavicular joint dislocation (ACJD).

Methods

A retrospective analysis was carrideout on the clinical data of patients who underwent arthroscopic suspension fixation without coracoid bone tunnel for ACJD treatment at Jiangning Hospital affiliated with Nanjing Medical University during January 2022 to December 2024 were included. Clinical data collected included age, sex, Rockwood classification, operative time, pre- and postoperative visual analog scale (VAS) pain scores on the first postoperative day, and Constant-Murley shoulder scores at six months after surgery. The size of the coracoclavicular interval was measured through X rays before surgery, one day, one and six months after surgery to monitor any loss of reduction.Paired non-parametric tests, paired t tests, and one-way repeated-measures analysis of variance were used separately to compare preoperative and postoperative VAS scores, shoulder joint scores, and changes in the coracoclavicular interval.

Results

A total of 21 patients with ACJD were included, all treated with arthroscopic suspension fixation without coracoid bone tunneltechnique. Among them, there were 11 males and 10 females, with a median age of 39 years. The average duration from injury to surgery was (2.8±1.0) d, and the mean surgical duration was (118±11) min. Postoperative VAS scores significantly decreased (Z=-230.0, P<0.001). The Constant-Murley score also significantly improved (t=30.90, P<0.001). The coracoclavicular distances before surgery,one day, one and six months after surgery were (24.0±4.1) mm, (5.2±1.0) mm, (5.6±1.1) mm, and (5.7±1.1) mm, respectively. The differences of coracoclavicular intervals among the time points of before surgery, one day, one month and six months after surgery were statistically significant (corrected F=467.10, P<0.001). The coracoclavicular intervals at one day, one month, and six months after surgery were significantly smaller than the preoperative values (all P<0.001), while there was no significant difference in the coracoclavicular distance between one day, one and six months after surgery (all P>0.05).

Conclusion

Arthroscopic suspension fixation without coracoid bone tunnel for ACJD can relieve shoulder joint pain, maintain shoulder joint function, and achieve satisfactory clinical efficacy.

Key words: Acromioclavicular joint, Joint dislocations, Arthroscopy, Coracoid process

图1 手术入路及解剖暴露。图A为手术入路，包括后方入路(红色P)置入关节镜、前方入路(红色A)显露喙突基底部以及锁骨远端2 cm切口；图B为关节镜下暴露喙突；图C为ACL（前交叉韧带）导向器建立锁骨隧道

Figure 1 Surgical approach and anatomical exposure. A is the surgical approach, including the posterior approach (red P) for arthroscope insertion, the anterior approach (red A) for exposure of the coracoid base, and a two centimetres incision at the distal clavicle; B is arthroscopic exposure of the coracoid process; C is ACL（anterior cruciate ligament） guide for creation of the clavicular bone tunnel

图2 关节镜下无喙突骨隧道的悬吊固定术过程。图A为经前方入路抓取预置的两根PDS线（聚二氧六环酮缝合线）尾端；图B为抓取两根PDS至体外打结形成的一根连续牵引线；图C为建立锁骨骨隧道；图D为5-0不可吸收线(黑色箭头所示)固定襻环与钛板；图E为关节镜直视下探钩调整襻环，避免软组织嵌入喙突下缘与襻环间；图F为术中透视显示满意的关节复位情况；图G为手术缝合口；图H为手术效果模式图

Figure 2 Surgical procedure of arthroscopic suspension fixation without coracoid bone tunnel. A shows grasping the tail ends of two pre-placed PDS（polydioxanone suture） via the anterior approach；B shows grasping the two PDS sutures out of the body and tying them to form a continuous traction suture；C is creation of the clavicular bone tunnel；D shows fixation of the loop and titanium plate with 5-0 non-absorbable suture (indicated by the black arrow)；E shows adjusting the loop with a probe under arthroscopic visualization to prevent soft tissue entrapment between the inferior border of the coracoid process and the loop；F is intraoperative fluoroscopy showing satisfactory joint reduction；G is surgical suture site；H is schematic diagram of surgical outcome

表1 ACJD患者术前和术后评估指标比较分析（n=21）

Table 1 Comparative analysis of preoperative and postoperative indicators in ACJD patients (n=21)

时间Time	VAS[M（P₂₅，P₇₅）]	Constant-Murley评分（±s）	喙锁间隙[mm，（±s）]Coracoclavicular distance
术前Before operation	5.0（4.0，6.5）	52.0±5.6	24.0±4.1
术后第1天One day after operation	0（0，1.0）	-	5.2±1.0
术后1个月One month after operation	-	-	5.6±1.1
术后6个月Six months after operation	-	93.0±4.6	5.7±1.1
统计值Statistical values	Z=-230.00	t=30.90	F=467.10
P值	<0.001	<0.001	<0.001

表1 ACJD患者术前和术后评估指标比较分析（n=21）

Table 1 Comparative analysis of preoperative and postoperative indicators in ACJD patients (n=21)

时间Time	VAS[M（P₂₅，P₇₅）]	Constant-Murley评分（±s）	喙锁间隙[mm，（±s）]Coracoclavicular distance
术前Before operation	5.0（4.0，6.5）	52.0±5.6	24.0±4.1
术后第1天One day after operation	0（0，1.0）	-	5.2±1.0
术后1个月One month after operation	-	-	5.6±1.1
术后6个月Six months after operation	-	93.0±4.6	5.7±1.1
统计值Statistical values	Z=-230.00	t=30.90	F=467.10
P值	<0.001	<0.001	<0.001

图3 关节镜下无喙突骨隧道悬吊式固定治疗急性右肩锁关节脱位手术前后影像。图A为右肩术前正位X线片，示RockwoodⅢ型肩锁关节脱位；图B为右肩术后第1天X线片显示肩锁关节复位良好；图C为术后1个月肩关节CT，示右肩锁关节前后向复位良好；图D为术后半年随访X线片，示右肩锁关节仍在位

Figure 3 Pre-and postoperative images of acute right ACJD （acromioclavicular joint dislocation) treated with arthroscopic suspension fixation without coracoid bone tunnel. A is X-ray image at anteroposterior view of right shoulder before surgery, showing Rockwood typeⅢ acromioclavicular joint dislocation；B is X-ray image at anteroposterior view of right shoulder one day after surgery, showing satisfactory reduction of the acromioclavicular joint；C is CT image of right shoulder one month after surgery, showing satisfactory anteroposterior reduction of the acromioclavicular joint；D is X-ray image at anteroposterior view of right shoulder six months after surgery, showing the acromioclavicular joint remained in position

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Arthroscopic suspension fixation without coracoid bone tunnel for acute acromioclavicular joint dislocation

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Arthroscopic suspension fixation without coracoid bone tunnel for acute acromioclavicular joint dislocation