Edwards Sara L, Wilson Nicole A, Flores Steven E, Koh Jason L, Zhang Li-Qun
Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA.
Arthroscopy. 2007 Dec;23(12):1278-84. doi: 10.1016/j.arthro.2007.07.004.
The purposes of this study were to assess the effects of a distal clavicle resection of less than 5 mm on bony contact and compliance in the acromioclavicular (AC) joint and to localize areas of persistent contact in the AC joint. The hypothesis of this study was that AC contact can be avoided by excising less than 5 mm of bone from the distal clavicle.
Ten human AC joints underwent compressive loading of the distal clavicle into the acromion after the following: disk excision, distal clavicle resection of 2.5 mm, and distal clavicle resection of 5 mm. The joint resistance force, stiffness, and presence and location of contact were monitored.
Excising 2.5 mm or less resulted in no bone-to-bone abutment in 6 of 10 specimens. A 5-mm resection resulted in successful decompression in all specimens. The specimens that required a 5-mm resection had minimal contact after the 2.5-mm resection (inferior-posterior quadrant only). AC joint stiffness decreased significantly with increasing amounts of clavicular resection (P = .01).
A 5-mm distal clavicle resection guaranteed no abutment but decreased joint stiffness. Persistent contact occurred only in the inferior-posterior quadrant of the joint after a 2.5-mm resection.
These findings support the efficacy of a 5-mm distal clavicle resection for eliminating bony contact but suggest that there is a bony contribution to AC joint stiffness. A resection of 2.5 to 5.0 mm could be adequate if care is taken to excise a greater depth of bone in the inferior-posterior quadrant.
本研究的目的是评估锁骨远端切除小于5毫米对肩锁关节（AC）的骨接触和顺应性的影响，并确定AC关节中持续接触的区域。本研究的假设是，通过从锁骨远端切除小于5毫米的骨可以避免AC关节接触。
在进行以下操作后，对10个尸体AC关节施加将锁骨远端压入肩峰的压缩负荷：切除椎间盘、切除2.5毫米的锁骨远端以及切除5毫米的锁骨远端。监测关节阻力、刚度以及接触的存在和位置。
切除2.5毫米或更少时，10个标本中有6个未出现骨与骨的邻接。切除5毫米可使所有标本成功减压。需要切除5毫米的标本在切除2.5毫米后仅有最小程度的接触（仅在关节后下象限）。随着锁骨切除量的增加，AC关节刚度显著降低（P = 0.01）。
切除5毫米的锁骨远端可确保无邻接，但会降低关节刚度。在切除2.5毫米后，持续接触仅发生在关节的后下象限。
这些发现支持切除5毫米锁骨远端以消除骨接触的有效性，但表明骨对AC关节刚度有影响。如果注意在关节后下象限切除更深的骨，切除2.5至5.0毫米可能就足够了。
