Huang Tsan-Wen, Hsieh Pang-Hsin, Huang Kuo-Chung, Huang Kuo-Chin
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chiayi, 6, West Sec, Chia-Pu Rd, Pu-Tz, Chia-Yi, 613, Taiwan.
Clin Orthop Relat Res. 2009 Aug;467(8):2142-8. doi: 10.1007/s11999-008-0684-7. Epub 2009 Jan 9.
Surgical reconstruction of the coracoclavicular ligament is a fundamental part of management of high-grade acromioclavicular dislocations and Type II lateral third clavicular fractures. However, no single surgical procedure is fully satisfactory because of failure or complications. We present an alternative coracoclavicular stabilization technique, which avoids the use of hardware or tendon graft, that was used in 10 consecutive patients with complete coracoclavicular ligament disruptions. These patients were followed for a minimum of 14 months (average, 34.8 months; range, 14-55 months). At the final followup, functional outcome measurement instruments (University of California-Los Angeles shoulder rating system and Western Ontario Shoulder Instability Index) and radiographic analysis were adopted as the main outcome measures of shoulder function. The mean University of California-Los Angeles shoulder rating score and the mean Western Ontario Shoulder Instability Index aggregation score at 12 months after surgery were 33.8 (95% confidence interval, 32.8-34.8) and 93.4 (95% confidence interval, 88.2-98.6), respectively. The radiographic analysis revealed all patients had maintained reduction on radiographs at the final followup. These preliminary results suggest that this simple technique can achieve stable coracoclavicular reconstruction and facilitate healing of the repaired ligaments or fractures.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
喙锁韧带的手术重建是治疗重度肩锁关节脱位和Ⅱ型锁骨外侧1/3骨折的重要组成部分。然而，由于失败或并发症，没有一种单一的手术方法能完全令人满意。我们提出了一种替代的喙锁稳定技术，该技术避免使用硬件或肌腱移植，连续应用于10例喙锁韧带完全断裂的患者。对这些患者进行了至少14个月的随访（平均34.8个月；范围14 - 55个月）。在最终随访时，采用功能结果测量工具（加利福尼亚大学洛杉矶分校肩评分系统和西安大略肩不稳定指数）和影像学分析作为评估肩部功能的主要结果指标。术后12个月时，加利福尼亚大学洛杉矶分校肩评分的平均得分和西安大略肩不稳定指数的平均汇总得分分别为33.8（95%置信区间，32.8 - 34.8）和93.4（95%置信区间，88.2 - 98.6）。影像学分析显示，所有患者在最终随访时X线片上均维持复位。这些初步结果表明，这种简单的技术可以实现稳定的喙锁重建，并促进修复韧带或骨折的愈合。
IV级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
