Grutter Paul W, Petersen Steve A
Department of Orthpaedic Surgery, 1st Medical Group/SGOSO, United States Air Force, 45 Pine Street, Langley Air Force Base, Virginia 23665-2080, USA.
Am J Sports Med. 2005 Nov;33(11):1723-8. doi: 10.1177/0363546505275646. Epub 2005 Aug 10.
Current surgical treatments for acromioclavicular separations do not re-create the anatomy of the acromioclavicular joint.
Anatomical acromioclavicular reconstruction re-creates the strength of the native acromioclavicular joint and is stronger than a modified Weaver-Dunn repair.
Controlled laboratory study.
The native acromioclavicular joint in 6 fresh-frozen cadaveric upper extremities was stressed to failure under uniaxial tension in the coronal plane. A modified Weaver-Dunn procedure, anatomical acromioclavicular reconstruction using a palmaris longus graft, and anatomical acromioclavicular reconstruction using a flexor carpi radialis graft were then performed sequentially. Each repair was stressed to failure. Load-displacement curves and mechanism of failure were recorded for each.
Loads at failure for the native acromioclavicular joint complex, modified Weaver-Dunn procedure, anatomical acromioclavicular reconstruction using a palmaris longus tendon graft, and anatomical acromioclavicular reconstruction using a flexor carpi radialis tendon graft were 815 N, 483 N, 326 N, and 774 N, respectively. The strength of the native acromioclavicular joint complex was significantly different from the modified Weaver-Dunn repair (P < .001) and the anatomical acromioclavicular reconstruction using a palmaris longus tendon graft (P < .001) but not from the anatomical acromioclavicular reconstruction using a flexor carpi radialis tendon graft (P = .607).
The strength of the described anatomical acromioclavicular reconstruction is limited by the tendon graft used. Anatomical acromioclavicular reconstruction with a flexor carpi radialis tendon graft re-creates the tensile strength of the native acromioclavicular joint complex and is superior to a modified Weaver-Dunn repair.
目前针对肩锁关节分离的手术治疗无法重建肩锁关节的解剖结构。
解剖学肩锁关节重建可恢复天然肩锁关节的强度，且比改良的Weaver-Dunn修复更强。
对照实验室研究。
对6具新鲜冷冻尸体上肢的天然肩锁关节在冠状面进行单轴拉伸直至破坏。然后依次进行改良的Weaver-Dunn手术、使用掌长肌腱移植的解剖学肩锁关节重建以及使用桡侧腕屈肌腱移植的解剖学肩锁关节重建。对每次修复都进行拉伸直至破坏。记录每次修复的载荷-位移曲线和破坏机制。
天然肩锁关节复合体、改良的Weaver-Dunn手术、使用掌长肌腱移植的解剖学肩锁关节重建以及使用桡侧腕屈肌腱移植的解剖学肩锁关节重建的破坏载荷分别为815 N、483 N、326 N和774 N。天然肩锁关节复合体的强度与改良的Weaver-Dunn修复（P < .001）和使用掌长肌腱移植的解剖学肩锁关节重建（P < .001）有显著差异，但与使用桡侧腕屈肌腱移植的解剖学肩锁关节重建无显著差异（P = .607）。
所述解剖学肩锁关节重建的强度受所用肌腱移植的限制。使用桡侧腕屈肌腱移植的解剖学肩锁关节重建可恢复天然肩锁关节复合体的拉伸强度，且优于改良的Weaver-Dunn修复。
