Department of Orthopaedic Surgery and Rehabilitation, University of Iowa, Iowa City, IA, USA.
J Shoulder Elbow Surg. 2013 Jun;22(6):775-81. doi: 10.1016/j.jse.2012.07.009. Epub 2012 Sep 13.
Sternoclavicular joint (SCJ) instability is relatively rare. Surgical treatment may be considered for severely displaced dislocations or symptomatic recurrent anterior instability. The purpose of this study was to describe an SCJ ligament reconstruction technique and retrospectively evaluate its safety and effectiveness for treating anterior SCJ dislocations and instability.
A retrospective review of demographics, medical history, injury characteristics, and pretreatment pain and functional levels was performed. A soft-tissue graft woven in a Roman numeral X pattern through clavicular and sternum subcortical bone tunnels was used. Patients were evaluated with postoperative visual analog scale (VAS) and functional scores, and their ability to return to normal preoperative sports and activities was determined.
Six patients were evaluated with a mean follow-up of 40 months (range, 24.5-58 months). Injury mechanisms included acute trauma (3 patients), minor trauma (1 patient), and chronic atraumatic instability (2 patients). The mean preoperative symptom duration was 11 months (range, 0.5-27.5 months). Autograft hamstring graft was used in all cases with no resulting surgical complications. All 6 patients had full range of motion with no instability after treatment. Five patients had no pain (0 of 10 on VAS), whereas one patient had mild pain (1 to 3 of 10 on VAS). All 6 patients had improved functional scores. All returned to preoperative activities and participation in sports. No recurrent instability occurred. In 1 case, failure occurred at 4 years with recurrent pain, and revision was performed.
The results of our study indicate that reconstruction for anterior SCJ dislocation is safe with results comparable to previously described surgical stabilization techniques. This technique provides a surgical treatment option for symptomatic anterior SCJ dislocation and instability.
胸锁关节（SCJ）不稳定相对少见。对于严重移位的脱位或有症状的复发性前向不稳定，可考虑手术治疗。本研究的目的是描述一种 SCJ 韧带重建技术，并回顾性评估其治疗前 SCJ 脱位和不稳定的安全性和有效性。
对患者的人口统计学资料、病史、损伤特征、术前疼痛和功能水平进行回顾性分析。使用 X 形编织的软组织移植物穿过锁骨和胸骨皮质骨隧道。通过术后视觉模拟评分（VAS）和功能评分评估患者，并确定其恢复正常术前运动和活动的能力。
6 例患者平均随访 40 个月（范围 24.5-58 个月）。损伤机制包括急性创伤（3 例）、轻微创伤（1 例）和慢性非创伤性不稳定（2 例）。术前症状持续时间平均为 11 个月（范围 0.5-27.5 个月）。所有病例均采用自体腘绳肌腱移植物，无手术并发症。治疗后所有患者均活动度完全正常且无不稳定。5 例患者无疼痛（VAS 评分为 0/10），1 例患者轻度疼痛（VAS 评分为 1-3/10）。所有患者的功能评分均有所改善。所有患者均恢复术前活动和运动参与，无复发性不稳定。1 例患者在 4 年后出现复发疼痛，行翻修手术。
我们的研究结果表明，前 SCJ 脱位的重建是安全的，其结果可与先前描述的手术稳定技术相媲美。该技术为有症状的前 SCJ 脱位和不稳定提供了一种手术治疗选择。
