| BackgroundAcromioclavicular joint dislocation(ACJD)is a common shoulder sports injury,which accounts for about 3.2%of total body dislocation.There are three main types of dislocation(Allman classification,Rockwood classification,Tossy classification).In the treatment of a variety of methods,it is generally believed that type ?,type ?acute dislocation should be conservative treatment,?,?,? type of acute dislocation should be treated by surgery,and type ? acute dislocation should be conservative treatment.It has also been suggested that surgery should be recommended for type ?ACJD,especially in young and active patients.There are various methods for treatment.At present,there are more than 30 surgical methods.Although there are many surgical methods,there are limitations and there is no recognized ideal surgical plan.At present,the application of various internal fixation methods for the treatment of ACJD requires open reduction,trauma,bleeding volume,destruction of local blood flow,poor joint function after surgery,and a certain infection rate,resulting in failure of internal fixation,which is obviously The principle of minimally invasive treatment of fractures at present is not consistent,which urgently requires us to explore a new treatment.Now more commonly used methods are:1 percutaneous Kirschner internal fixation;2 intercondylar compression screw fixation;3 clavicle end resection;4AO clavicular hook plate treatment ACJD;5Endobutton.technology reconstruction coracoclavicular ligament treatment AC JD and so on.The AO/ASIF,headed by Muller,summarized the previous failures in fixation,and proposed the AO theory of traumatic internal fixation in the early 1960s,namely:1 Anatomical reduction;2 Strong internal fixation;3 painless function training;4 non-invasive or minimally invasive surgical techniques.However,with the continuous development of clinical applications and biomechanical research,the related AO theory and the disadvantages of its corresponding internal fixation equipment have gradually been recognized and valued by the industry.In recent years,the concept and mode of fracture fixation have gradually evolved to the BO theory.The four internal fixation principles of the BO theory are gradually becoming the guiding direction for the development of traumatic internal fixation and related internal fixation devices,namely:1 to strengthen internal fixation as biology Fixed;2 full attention to bone and soft tissue blood supply;3 minimally invasive techniques to restore the stability of the fracture anatomy;4 early functional exercise rationalization and personalization.Therefore,we believe that minimally invasive treatment will become a trend in the development of wound treatment.How to select appropriate internal fixation materials according to different types of injuries,improve surgical techniques,minimize surgical trauma,and how to restore patients' functional activities earlier,etc.Is the key to the problem.ObjectiveAt present,the application of various internal fixation methods for the treatment of AC JD requires open reduction,complications are large trauma,bleeding,more damage to blood supply,postoperative joint dysfunction,there is a certain rate of infection,resulting in internal fixation failure,which obviously is not consistent with the minimally invasive treatment principle of fracture.There's no known ideal surgical plan.The purpose of this study was to discuss the basic theory and method of minimally invasive surgery for acromioclavicular joint dislocation,to explore the functional anatomical features,clinical significance,biomechanics,injury mechanism and related basic research of acromioclavicular joint,to judge the main influencing factors in maintaining the stability of acromioclavicular joint and to guide the clinical treatment.This study discusses percutaneous minimally invasive surgery method in the ultrasound navigation technique,carries on the clinical case analysis,the appraisal curative effect,and compared with the traditional operation,given the superiority of the minimally invasive surgery.Subjects1.Ten fresh specimens of frozen male adult shoulder specimens provided by the Department of Anatomy,Wenzhou Medical University,were collected.2.The study population was from March 2015 to June 2017 in the selection of 45 adult patients diagnosed with ACJD by X-ray,and the selection of 25 normal adult men(male group)and 20 adult women(female group).MethodsThe basic and clinical research of ACJD minimally invasive treatment strategies are two parts:Basic analysis section1.Comparative Experiment Analysis of shoulder specimens of 10 specimens,aged 35-72 years old,average(45.34 ± 6.39)years old,all specimens without shoulder deformity,trauma and surgical changes.Ten specimens of bone-ligament-bone structure were trimmed and randomly divided into experimental group and control group.The experimental group retained only the coracoclavicular ligament and cut the acromioclavicular ligament.The control group retained only the acromioclavicular ligament and cut the coracoclavicular ligament,comparison of biomechanical experiments.2.Clinical research sectionThe study subjects were from March 2015 to June 2017 in the selection of 45 patients with ACJD diagnosed by X-ray,25 males and 20 females;aged 23-65 years,average(35.3416.39)years old;injured Time to medical treatment was 2 to 12 days with an average interval of(6.3813.23)days.Causes of injuries:15 cases of car accident injuries,11 cases of wrestling injuries,and 19 cases of fall injuries;23 cases on the left side and 22 cases on the right side;all patients for blunt trauma,no other injuries are combined.In the supine position,the probe is placed sagittally and coronally,the imaging features of the lower acromioclavicular joint are super-acousticized after ACJD,and the sagittal dislocation septum spacing and the normal lateral septal distance are measured.Patients and their families signed informed consent and the study was approved by the Ethics Committee of the Medical College of Shandong University.Forty-five patients with ACJD were divided into two groups according to the random number table.25 patients in the minimally invasive group were treated with ultrasound-guided percutaneous minimally invasive ACJD.In the traditional group,20 patients were treated with traditional internal fixation.There was no significant difference in the general data between the two groups(P>0.05),and they were comparable.The study was conducted from March 2015 to June 2017 in the selection of 25 normal adult males(male group)and 25 adult females(female group).Doppler color ultrasound system was used to adjust to Muscle mode using a line array probe(5-10 MHz).The patient was placed in supine position.The patient was placed in a supine position.The probe was placed on the coronal and sagittal positions.The ultrasound images of the subclavian and condylar processes and their surrounding vasculature were observed.The image features of the corresponding structures were analyzed and identified.The distance from the superior edge of the sagittal clavicle to the condyle was measured.Data analysis SPSS 19.0 was used for statistical analysis,age,clinical symptom index(skin incision length,operation time,intraoperative blood loss,incision healing time),length of hospital stay,cost of surgery,inflammatory factor level,VAS score The Constant-Murley score was expressed as(x ±s).Using the t-test,sex,limb,cause,Lazzcano,and Karlsson criteria and complications were expressed in n(%).Comparison was performed using the x2 test.Sequential categorical variables should be selected Ridit analysis,P<0.05 was considered statistically significant.ResultsBasic analysis sectionThe ligament tensile rupture strength of the experimental group was(514.05±40.34)N,which was less than that of the control group(565.24±46.26)N.There was a significant difference between the two groups(P<0.05),indicating that the strength of the coracoclavicular ligament was lower than that of the shoulder.The ligament is strong,but it has a certain degree of stability to maintain the clavicle,which can not be ignored in clinical treatment.At the same time,the distance from the distal end of the oblique ligament attachment point to the distal clavicle was(19.25±1.76)mm,and the distance from the distal end of the attachment point of the tapered ligament to the distal clavicle was(36.21±2.37)mm.Biomechanical experimental data show that the atrial scapula ligament has a greater tensile rupture strength than the coracoclavicular ligament.Therefore,in the ACJD injury mechanism,The acromioclavicular ligament mainly maintains the horizontal stability of the acromioclavicular joint,and the coracoclavicular ligament mainly maintains the vertical stability of the acromioclavicular joint.the coracoclavicular ligament begins to bear the force after the acromioclavicular ligament is completely ruptured,which indirectly reminds us to repair the coracoclavicular ligament during surgery.Both of them can not be neglected in clinical treatment.2.Clinical research sectionThere was no significant difference in the general clinical data(age,sex,limb,cause)between the two groups(P>0.05).The normal male group was perpendicular to the condyle of the upper clavicle(32.3410.23)mm,right shoulder(32.3610.22)mm and normal female group left shoulder(29.79±0.15)mm,right shoulder(29.84±0.16)mm.There was no significant difference in distance between the two groups(P>0.05).At the same time,there was no statistical difference between the vertical distances from the upper clavicle to the condyle of the left shoulder and right shoulder in the male and female groups(P>0.05).ACJD male group normal side(31.48 ± 0.19)mm,dislocation side(40.39 ± 0.41)mm and ACJD female group normal side(28.57 ± 0.13)mm,dislocation side(39.57 ± 0.33)mm ultrasonic upper clavicle to the condyle There was a statistically significant difference in the vertical distance(P<0.05).At the same time,there was a statistically significant difference in the vertical distance between the superior and the superior condyle of the dislocation of the male group and the female group(P<0.05).The clinical symptoms of the minimally invasive group were skin incision length(2.49±0.29)cm,operation time(33.35±9.38)min,intraoperative blood loss(14.34±6.23)ml,and incision healing time(8.33± 1.05)d all significantly less than traditional The groups were statistically different(P<0.05).In the minimally invasive group,the average postoperative hospital stay was(2.35±1.03)days,the operation cost was(7234.35±439.38)yuan,and the incision healing time was(8.33± 1.05)days,which was significantly lower than that of the traditional group.There was a statistically significant difference(P<0.05).In the minimally invasive group,Karls son's rating standard grade A accounted for 68.00 percent,and the excellent and good rate was 96.00 percent,which was significantly higher than the 50.00 percent and 70.00 percent of the traditional group,respectively.There was a statistically significant difference(P<0.05).There was no significant difference in preoperative Constant-Murley evaluation criteria scores(P>0.05).Postoperatively,patients in the minimally invasive group had a higher Constant-Murley score(95.23±4.65)than the traditional group(89.25±4.38).Points,there are statistically significant differences(P<0.05).In the minimally invasive group,the Lazzcano evaluation standard score was 70.00%,and the excellent and good rate was 92.0%,which was significantly higher than that of the traditional group(60.00%,70.00%,respectively).There was a statistically significant difference(P<0.05).Before treatment,there was no significant difference in VAS scores between the two groups(P>0.05).There was a significant difference in the VAS scores between the two groups before and after treatment(P<0.05).Before treatment,there was no significant difference in the levels of hs-CRP,IL-6 and TNF-a between the two groups(P>0.05).Before and after treatment,the levels of hs-CRP,IL-6 and TNF-a in each group were compared.Significantly(P<0.05);after treatment,hs-CRP(4.19±1.04)mg/L,IL-6(1.71±0.24)mg/L,and TNF-a(0.71±0.11)?pg/L in the minimally invasive group.The indicator level was significantly better than the traditional group,with significant differences(P<0.05).After follow-up,none of the patients had internal fixation loosening,nail removal,no further dislocation of the acromioclavicular joint.Conclusion1.The acromioclavicular ligament can effectively stabilize the stability of the acromioclavicular joint,and the repair of the acromioclavicular ligament should be done during clinical surgery.Under the precondition of minimally invasive operation and good fixation,it is feasible to repair ligament without direct incision,which provides a theoretical basis for minimally invasive treatment of AC JD.2.Minimally invasive percutaneous minimally invasive fixation of ACJD using B-navigation.Minimally invasive surgery can avoid important vascular and nerve injuries in the surgical area.Percutaneous fixation is only performed.The wound is small and the residual scar is small.After a good,postoperative patient shoulder function is good,and the operation is relatively simple,economical,suitable for use in most hospitals.Our pioneering ultrasound-guided percutaneous minimally invasive surgery can shorten the operation time,reduce the surgical trauma,improve the safety of operation,reduce the complications of surgery,facilitate early functional exercise,and maximize the recovery of shoulder function,consistent with biological fixation(The requirements of BO viewpoint)cater to the minimally invasive surgery advocated by most orthopedic scientists. |
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