Freedman Brett A, Javernick Matthew A, O'Brien Frederick P, Ross Amy E, Doukas William C
Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC, USA.
J Shoulder Elbow Surg. 2007 Jul-Aug;16(4):413-8. doi: 10.1016/j.jse.2006.10.006. Epub 2007 Apr 19.
The purpose of this report is to compare outcomes after arthroscopic versus open distal clavicle excision in the treatment of refractory acromioclavicular joint pain. A randomized, prospective clinical trial comparing the 6-month and 1-year outcomes of patients undergoing open distal clavicle excision (group 1) with those undergoing arthroscopic distal clavicle excision (group 2) was carried out. The Modified American Shoulder and Elbow Surgeons form, visual analog scale pain score, Short Form 36, and satisfaction questions were assessed preoperatively and at 6 months and 1 year postoperatively. Seventeen patients were enrolled. There was a trend across all measures for earlier or better outcomes (or both) after arthroscopic over open treatment. The improvement in visual analog scale pain score from preoperatively to 1 year postoperatively was significant for group 2 but not group 1 (P = .006 vs P = .13). Occult intra-articular pathology was detected and treated in 50% of group 2 patients. Arthroscopic and open distal clavicle excisions both provide significant pain reduction at 1 year. Both are effective surgeries for the treatment of refractory acromioclavicular joint pain. The ability to diagnosis and treat subtle concomitant shoulder pathology is a unique advantage of the arthroscopic approach.
本报告的目的是比较关节镜下与开放性远端锁骨切除术治疗难治性肩锁关节疼痛后的疗效。开展了一项随机、前瞻性临床试验，比较接受开放性远端锁骨切除术的患者（第1组）与接受关节镜下远端锁骨切除术的患者（第2组）6个月和1年的疗效。术前以及术后6个月和1年评估改良美国肩肘外科医师协会表格、视觉模拟评分疼痛评分、简明健康状况调查量表36以及满意度问题。共纳入17例患者。在所有指标上，关节镜治疗较开放治疗均呈现出早期或更好疗效（或两者兼具）的趋势。第2组从术前到术后1年视觉模拟评分疼痛评分改善显著，而第1组不显著（P = 0.006对比P = 0.13）。第2组50%的患者检测到并治疗了隐匿性关节内病变。关节镜下和开放性远端锁骨切除术在1年时均能显著减轻疼痛。两者都是治疗难治性肩锁关节疼痛的有效手术。诊断和治疗细微的伴随肩部病变的能力是关节镜手术方法的独特优势。
