Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Republic of Korea.
Injury. 2012 Feb;43(2):213-8. doi: 10.1016/j.injury.2011.08.003. Epub 2011 Sep 3.
Numerous surgical methods are used to treat acromioclavicular (AC) joint dislocations, and an anatomical reconstruction using a free tendon graft has attracted considerable attention, particularly for chronic cases. The purpose of this study was to introduce the results of lateral half conjoined tendon (LHCT) and coracoacromial ligament (CAL) transfer for chronic type V injuries.
A retrospective evaluation was performed on the clinical and radiographic outcomes of the 12 patients who underwent LHCT and CAL transfer for chronic type V AC injuries and had been followed for 2 years postoperatively. All 12 patients were males with a mean age of 37.3 ± 7.7 years (range: 26-49 years) at surgery. The causes of the injury were traffic accidents (five), falls (three) and sports injuries (four). The mean time elapsed between trauma and surgery was 12.5 ± 5.4 weeks (range: 7-22 weeks).
No reduction loss was observed at the final follow-up. The postoperative coracoclavicular (CC) distance was 8.9 ± 1.6mm, which represented a significant improvement versus the preoperative status (20.3 ± 3.0mm; p < 0.001), and no significant difference was observed between the injured and uninjured contralateral sides (8.7 ± 0.8mm), postoperatively (p = 0.619). The temporary use of a Steinman pin for AC fixation did not cause any complications. On the other hand, there were eight cases of mild radiographic arthrosis at the AC joint and two cases of heterotopic ossification of the CC space, although neither affected the functional outcomes. The mean modified UCLA score was 18.5 ± 2.1 (range: 12-20), which represented an excellent result in 11 of the 12 cases. The single case with a poorer postoperative score had a pre-existing brachial plexus injury.
Despite the small study cohort, the results of LHCT and CAL transfer in chronic type V AC separation are promising. CAL transfer alone has been shown to be biomechanically insufficient for an AC reconstruction, particularly in chronic situations. The advantage of LHCT transfer is that it does not require a distant donor site or incur the costs of an allograft or implant.
目前有许多治疗肩锁关节（AC）脱位的手术方法，其中使用游离肌腱重建的解剖重建方法引起了广泛关注，尤其是对于慢性病例。本研究旨在介绍使用外侧半连接肌腱（LHCT）和肩锁韧带（CAL）转位治疗慢性 V 型损伤的结果。
对 12 例接受 LHCT 和 CAL 转位治疗慢性 V 型 AC 损伤的患者进行回顾性评估，术后随访 2 年。所有患者均为男性，手术时的平均年龄为 37.3 ± 7.7 岁（26-49 岁）。损伤原因分别为交通事故（5 例）、跌倒（3 例）和运动损伤（4 例）。创伤至手术的平均时间为 12.5 ± 5.4 周（7-22 周）。
末次随访未见复位丢失。术后喙锁（CC）距离为 8.9 ± 1.6mm，与术前相比有显著改善（20.3 ± 3.0mm；p < 0.001），且与健侧相比无显著差异（8.7 ± 0.8mm），术后（p = 0.619）。AC 固定用临时斯氏针无并发症。另一方面，有 8 例 AC 关节轻度放射状关节炎，2 例 CC 间隙异位骨化，但均不影响功能结果。改良 UCLA 评分平均为 18.5 ± 2.1（12-20），12 例中有 11 例为优秀。评分较差的唯一病例存在先前存在的臂丛神经损伤。
尽管研究队列较小，但 LHCT 和 CAL 转位治疗慢性 V 型 AC 分离的结果很有前景。CAL 单独转位在 AC 重建中生物力学不足，特别是在慢性情况下。LHCT 转位的优点是不需要远处供体部位，也不需要使用同种异体移植物或植入物。
